Provider Demographics
NPI:1366501405
Name:EAST VALLEY SURGICAL ASSOCIATES,PLLC
Entity Type:Organization
Organization Name:EAST VALLEY SURGICAL ASSOCIATES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-633-0505
Mailing Address - Street 1:1501 N GILBERT RD
Mailing Address - Street 2:207
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2390
Mailing Address - Country:US
Mailing Address - Phone:480-633-0202
Mailing Address - Fax:
Practice Address - Street 1:1501 N GILBERT RD
Practice Address - Street 2:207
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2390
Practice Address - Country:US
Practice Address - Phone:480-633-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86215Medicare UPIN