# MATERNAL FETAL MEDICINE OF ARIZONA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093050601
- **Authorized official:** RONALD ANDREW RUSSELL (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (480) 399-3880

## Contact information

- **Practice address:** 4852 E BASELINE RD, STE 104, MESA, AZ 85206-4627
- **Practice address phone:** (480) 467-3545
- **Practice address fax:** (480) 467-3565
- **Mailing address:** 8912 E PINNACLE PEAK RD, STE F9-585, SCOTTSDALE, AZ 85255-3659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | 40444 | AZ | Yes |

## Other

- **Enumeration date:** 12/07/2012
- **Last updated:** 01/18/2013