Provider Demographics
NPI:1033152301
Name:DESERT BLOOM OBSTERTRICS & GYNECOLOGY, PC
Entity Type:Organization
Organization Name:DESERT BLOOM OBSTERTRICS & GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-885-5300
Mailing Address - Street 1:6452 E CARONDELET DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710
Mailing Address - Country:US
Mailing Address - Phone:520-885-5300
Mailing Address - Fax:520-885-5309
Practice Address - Street 1:6452 E CARONDELET DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-885-5300
Practice Address - Fax:520-885-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AZ34677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
34677Medicare UPIN
F99951Medicare UPIN