Provider Demographics
NPI:1417906280
Name:HINDERKS DAVIS, BETTY A (MD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:HINDERKS DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:A
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10240 W INDIAN SCHOOL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5905
Mailing Address - Country:US
Mailing Address - Phone:623-243-9077
Mailing Address - Fax:623-271-9826
Practice Address - Street 1:10240 W INDIAN SCHOOL RD STE 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5905
Practice Address - Country:US
Practice Address - Phone:623-243-9077
Practice Address - Fax:623-271-9826
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33887207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ055923Medicaid
AZZ103571Medicare PIN
AZH82549Medicare UPIN
AZP00235405Medicare PIN
AZ055923Medicaid