Organization
SOUTHWEST EAR, NOSE, & THROAT SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE ADAIR PRATER (MANAGER)
(928) 486-3934
Entity
Organization
Contact information
Practice address
1760 MCCULLOCH BLVD N STE 100, LAKE HAVASU CITY, AZ 86403-6559
(928) 854-5368
(928) 854-4462
Mailing address
2331 HOGAN LN, LAKE HAVASU CITY, AZ 86406-8242
(928) 486-3934
(928) 854-4462
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
515877
—
AZ
Enumeration date
02/18/2020
Last updated
02/18/2020
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