Provider Demographics
NPI:1194809699
Name:NORTHERN ARIZONA SURGICAL
Entity type:Organization
Organization Name:NORTHERN ARIZONA SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-773-2500
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:#202
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-773-2500
Mailing Address - Fax:928-773-2502
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:#202
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1479
Practice Address - Country:US
Practice Address - Phone:928-773-2500
Practice Address - Fax:928-773-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26206208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418295Medicaid
AZ418295Medicaid
AZF92417Medicare UPIN