Basic Information
Provider Information
NPI: 1285688689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCIBETTA
FirstName: WILLIAM
MiddleName: CRAIG
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 645 E MISSOURI AVE
Address2: STE 300
City: PHOENIX
State: AZ
PostalCode: 850121351
CountryCode: US
TelephoneNumber: 6022628900
FaxNumber: 6022628890
Practice Location
Address1: 7600 N 15TH ST STE 290
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850204336
CountryCode: US
TelephoneNumber: 6022341803
FaxNumber: 6022343748
Other Information
ProviderEnumerationDate: 05/20/2006
LastUpdateDate: 07/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XG83848CAN Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X42994AZY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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