Provider Demographics
NPI:1003991753
Name:DESERT CENTER FOR ALLERGY AND CHEST DISEASES
Entity Type:Organization
Organization Name:DESERT CENTER FOR ALLERGY AND CHEST DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-788-7211
Mailing Address - Street 1:6970 E CHAUNCEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5158
Mailing Address - Country:US
Mailing Address - Phone:602-788-7211
Mailing Address - Fax:602-788-1890
Practice Address - Street 1:6970 E CHAUNCEY LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5158
Practice Address - Country:US
Practice Address - Phone:602-788-7211
Practice Address - Fax:602-788-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1549207KA0200X, 207RP1001X
AZ31223207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCKKXMedicare ID - Type Unspecified