# CRYSTAL CANYON ENT & FACIAL PLASTIC SURGERY PC

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

## Provider details

- **NPI number:** 1285780767
- **Authorized official:** MRS. PAMELA A TAYLOR (OFFICE MANAGER)
- **Authorized official phone:** (928) 774-1873

## Contact information

- **Practice address:** 1340 N RIM DR, FLAGSTAFF, AZ 86001-3111
- **Practice address phone:** (928) 774-1873
- **Practice address fax:** (928) 774-5525
- **Mailing address:** 1340 N RIM DR, FLAGSTAFF, AZ 86001-3111
- **Mailing address phone:** (928) 774-1873
- **Mailing address fax:** (928) 774-5525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | MD3000 | AZ | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | MD3000 | AZ | Yes |

## Other

- **Enumeration date:** 01/26/2007
- **Last updated:** 04/04/2013