# ATLANTIS MEDICAL GROUP AZ PLLC

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

## Provider details

- **NPI number:** 1740610039
- **Authorized official:** ROBERT PRESTON HARPER (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (505) 553-8466

## Contact information

- **Practice address:** 11047 N 19TH AVE, PHOENIX, AZ 85029-4816
- **Practice address phone:** (602) 589-0500
- **Practice address fax:** (602) 314-4552
- **Mailing address:** 11047 N 19TH AVE, PHOENIX, AZ 85029-4816
- **Mailing address phone:** (602) 802-8636
- **Mailing address fax:** (602) 314-4552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LA0401X | Addiction Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LA0401X | Addiction Medicine (Anesthesiology) Physician | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | NULL | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |

## Other

- **Enumeration date:** 11/22/2013
- **Last updated:** 08/25/2026