Provider Demographics
NPI:1154332807
Name:BUDNICK, PAUL ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALEXANDER
Last Name:BUDNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:A
Other - Last Name:BUDNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15070
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-5070
Mailing Address - Country:US
Mailing Address - Phone:602-386-9982
Mailing Address - Fax:484-231-9982
Practice Address - Street 1:807 S PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5542
Practice Address - Country:US
Practice Address - Phone:602-386-9982
Practice Address - Fax:484-231-9982
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34093207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020693Medicaid
AZ020693Medicaid
AZ020693Medicaid