Provider Demographics
NPI:1467647388
Name:DESERT HARBOR INTERNAL MEDICINE
Entity Type:Organization
Organization Name:DESERT HARBOR INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-548-7800
Mailing Address - Street 1:5757 W THUNDERBIRD RD
Mailing Address - Street 2:W310
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4649
Mailing Address - Country:US
Mailing Address - Phone:602-548-7800
Mailing Address - Fax:602-548-0006
Practice Address - Street 1:5757 W. THUNDERBIRD RD
Practice Address - Street 2:SUITE W310
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4649
Practice Address - Country:US
Practice Address - Phone:602-548-7800
Practice Address - Fax:602-548-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ321480Medicaid
F97526Medicare UPIN
107456Medicare PIN