Organization
KODY MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALEXANDER MATHURIN MD (CEO)
(602) 799-2133
Entity
Organization
Contact information
Practice address
11627 N 12TH PL, PHOENIX, AZ 85020-1222
(602) 799-2133
(602) 997-1418
Mailing address
11627 N 12TH PL, PHOENIX, AZ 85020-1222
(602) 799-2133
(602) 997-1418
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
23700
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23700
AZ LICENSE
AZ
Enumeration date
02/15/2012
Last updated
11/02/2012
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