Provider Demographics
NPI:1619031028
Name:SZPAIZMAN, SERGIO (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:SZPAIZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 N 3RD ST
Mailing Address - Street 2:SUITE 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1130
Mailing Address - Country:US
Mailing Address - Phone:602-323-3393
Mailing Address - Fax:602-323-3399
Practice Address - Street 1:1492 S MILL AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5652
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:480-927-1092
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ244583Medicaid
AZ1619031028OtherMEDICARE-NPI
AZ1619031028Medicare PIN