Individual
DR. ALBION FELLOWS HARGRAVE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1511
(602) 263-1619
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
9134
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407214
—
AZ
01
—
AZ0713140
BCBS
—
Enumeration date
09/26/2006
Last updated
07/09/2007
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