Organization
AZ FIDELIS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN A HALVORSON MD (CEO)
(877) 408-2488
Entity
Organization
Contact information
Practice address
7702 E DOUBLETREE RANCH RD, STE 300, SCOTTSDALE, AZ 85258-2129
(877) 408-2488
(866) 776-6641
Mailing address
7702 E DOUBLETREE RANCH RD, STE 300, SCOTTSDALE, AZ 85258-2129
(877) 408-2488
(866) 776-6641
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
13423
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13423
STATE LICENSE
AZ
Enumeration date
12/20/2008
Last updated
03/27/2012
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