# AZ FIDELIS PLLC

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

## Provider details

- **NPI number:** 1558507657
- **Authorized official:** GLEN A HALVORSON MD (CEO)
- **Authorized official phone:** (877) 408-2488

## Contact information

- **Practice address:** 7702 E DOUBLETREE RANCH RD, STE 300, SCOTTSDALE, AZ 85258-2129
- **Practice address phone:** (877) 408-2488
- **Practice address fax:** (866) 776-6641
- **Mailing address:** 7702 E DOUBLETREE RANCH RD, STE 300, SCOTTSDALE, AZ 85258-2129
- **Mailing address phone:** (877) 408-2488
- **Mailing address fax:** (866) 776-6641

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 13423 | AZ | Yes |

## Other

- **Enumeration date:** 12/20/2008
- **Last updated:** 03/27/2012