Provider Demographics
NPI:1225744253
Name:PHOENIX BARIATRIC LLC
Entity Type:Organization
Organization Name:PHOENIX BARIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEBARROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-485-8585
Mailing Address - Street 1:PO BOX 40640
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0640
Mailing Address - Country:US
Mailing Address - Phone:480-485-8585
Mailing Address - Fax:480-302-7818
Practice Address - Street 1:4860 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4670
Practice Address - Country:US
Practice Address - Phone:480-485-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty