Provider Demographics
NPI:1972783785
Name:JAMES J. BOUZOUKIS, MD, LLC
Entity type:Organization
Organization Name:JAMES J. BOUZOUKIS, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOUZOUKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-889-8877
Mailing Address - Street 1:9155 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1521
Mailing Address - Country:US
Mailing Address - Phone:480-889-8877
Mailing Address - Fax:480-889-8878
Practice Address - Street 1:9155 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1521
Practice Address - Country:US
Practice Address - Phone:480-889-8877
Practice Address - Fax:480-889-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30243207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ871823Medicaid
AZAZ0732540OtherAZ BLUE CROSS BLUE SHIELD
AZ1Z8392OtherHEALTHNET
AZ0997727OtherCIGNA
AZ=========OtherAETNA
AZ1Z8392OtherHEALTHNET
AZAZ0732540OtherAZ BLUE CROSS BLUE SHIELD
AZ=========OtherUNITED HEALTHCARE
AZH19226Medicare UPIN
AZ871823Medicaid