Provider Demographics
NPI:1427213404
Name:DOCTOR AFTER DARK, PLLC
Entity type:Organization
Organization Name:DOCTOR AFTER DARK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADNISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:480-206-3602
Mailing Address - Street 1:1311 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5707
Mailing Address - Country:US
Mailing Address - Phone:602-253-3565
Mailing Address - Fax:602-312-1316
Practice Address - Street 1:1311 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5707
Practice Address - Country:US
Practice Address - Phone:602-253-3565
Practice Address - Fax:602-312-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24255208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty