Provider Demographics
NPI:1235375486
Name:VIE, SERGIO ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:ADRIAN
Last Name:VIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10665 E GOLD DUST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-6004
Mailing Address - Country:US
Mailing Address - Phone:602-388-9335
Mailing Address - Fax:480-471-6123
Practice Address - Street 1:1310 N 24TH ST STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4617
Practice Address - Country:US
Practice Address - Phone:602-254-0200
Practice Address - Fax:602-254-0237
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17395207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAV8632300OtherDEA
AZAV8632300OtherDEA