Individual
DAVID CIVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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
207Q00000X
Family Medicine Physician
Primary
42516
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
711087
—
AZ
01
—
AZ727300
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
08/31/2006
Last updated
10/16/2014
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