Basic Information
| Provider Information | |||||||||
| NPI: | 1063440113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DROBNES | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M D | ||||||||
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| Mailing Information | |||||||||
| Address1: | SOUTHWEST DIAGNOSTIC IMAGING LTD | ||||||||
| Address2: | 5322 W. NORTHERN AVE | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804255063 | ||||||||
| FaxNumber: | 6239156924 | ||||||||
| Practice Location | |||||||||
| Address1: | SOUTHWEST DIAGNOSTIC IMAGING LTD | ||||||||
| Address2: | 5322 W. NORTHERN AVE | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804255063 | ||||||||
| FaxNumber: | 6239156924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 31662 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 785488 | 01 | AZ | MEDICAID/AHCCCS | OTHER |