Provider Demographics
NPI:1386790582
Name:WAZNY, PHILIP M (NMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:WAZNY
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 E DESERT COVE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6254
Mailing Address - Country:US
Mailing Address - Phone:480-993-3331
Mailing Address - Fax:480-800-3240
Practice Address - Street 1:9180 E DESERT COVE AVE STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6254
Practice Address - Country:US
Practice Address - Phone:480-993-3331
Practice Address - Fax:480-800-3240
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-914175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath