Individual
CARL ROBERT VANSELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3805 E BELL RD, SUITE 3100, PHOENIX, AZ 85032-2105
(602) 867-8644
(602) 795-5698
Mailing address
3805 E BELL RD STE 3100, PHOENIX, AZ 85032-2136
(602) 494-3656
(602) 867-3862
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2309
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z5306
HEALTHNET
AZ
05
—
495920
—
AZ
01
—
970013946
RAILROAD MEDICARE
AZ
Enumeration date
06/30/2005
Last updated
06/29/2022
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