Provider Demographics
NPI:1518063742
Name:VALLEY OF THE SUN MEDICAL CARE PC
Entity Type:Organization
Organization Name:VALLEY OF THE SUN MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-473-8866
Mailing Address - Street 1:9917 E BELL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2398
Mailing Address - Country:US
Mailing Address - Phone:480-473-8866
Mailing Address - Fax:480-473-8875
Practice Address - Street 1:9917 E BELL RD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2398
Practice Address - Country:US
Practice Address - Phone:480-473-8866
Practice Address - Fax:480-473-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224171Medicaid
AZ224171Medicaid
AZZ111084Medicare PIN