Provider Demographics
NPI:1154651750
Name:DESERT INTERVENTIONAL SPINE CONSULTANTS
Entity Type:Organization
Organization Name:DESERT INTERVENTIONAL SPINE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:YEDDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-361-7680
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-0097
Mailing Address - Country:US
Mailing Address - Phone:480-838-1914
Mailing Address - Fax:480-838-9434
Practice Address - Street 1:1410 W GUADALUPE RD STE 125
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3041
Practice Address - Country:US
Practice Address - Phone:480-838-1914
Practice Address - Fax:480-838-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34866174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty