Organization
PHOENIX ID LLC
Active
Organization
PHOENIX ID LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB OOMMEN MD (OWNER)
(480) 907-7786
Entity
Organization
Contact information
Practice address
340 E PALM LN STE 100, PHOENIX, AZ 85004-4528
(602) 254-1136
(602) 272-1720
Mailing address
3303 S LINDSAY RD STE 123, GILBERT, AZ 85297-2100
(480) 821-9339
(480) 821-9555
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
37316
AZ
Other
Enumeration date
08/08/2007
Last updated
10/09/2008
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