Provider Demographics
NPI:1477513745
Name:DESERT EAR, NOSE & THROAT MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:DESERT EAR, NOSE & THROAT MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WALZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-340-4566
Mailing Address - Street 1:71687 HIGHWAY 111 STE 101
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4515
Mailing Address - Country:US
Mailing Address - Phone:760-340-4566
Mailing Address - Fax:760-340-2481
Practice Address - Street 1:71687 HIGHWAY 111 STE 101
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4515
Practice Address - Country:US
Practice Address - Phone:760-340-4566
Practice Address - Fax:760-340-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ74532ZMedicare ID - Type UnspecifiedPROVIDER NUMBER