Organization
ARIZONA IOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW L. FORDYCE (MANAGING PARTNER)
(619) 458-6306
Entity
Organization
Contact information
Practice address
2301 WEST SANOQUE COURT, GILBERT, AZ 85298
(720) 503-5711
Mailing address
2907 SHELTER ISLAND DR., SUITE 105-612, SAN DIEGO, CA 92106-2743
(602) 734-1405
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
05/07/2015
Last updated
10/10/2018
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