Provider Demographics
NPI:1104176627
Name:HAMBURG, MORRIS BRUCE (ANP-C)
Entity type:Individual
Prefix:
First Name:MORRIS
Middle Name:BRUCE
Last Name:HAMBURG
Suffix:
Gender:M
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1261
Mailing Address - Country:US
Mailing Address - Phone:866-974-2673
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:10494 W THUNDERBIRD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-6122
Practice Address - Country:US
Practice Address - Phone:162-324-1870
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP8379363LA2200X
NC5005741363LA2200X
AZAP8379363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109731Medicaid
AZ109731Medicaid