Provider Demographics
NPI:1588654560
Name:DESERT WEST OBSTETRICS & GYNECOLOGY LTD
Entity Type:Organization
Organization Name:DESERT WEST OBSTETRICS & GYNECOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-978-1500
Mailing Address - Street 1:6678 W THUNDERBIRD RD # 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3721
Mailing Address - Country:US
Mailing Address - Phone:602-678-1500
Mailing Address - Fax:602-978-0409
Practice Address - Street 1:6678 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3721
Practice Address - Country:US
Practice Address - Phone:602-678-1500
Practice Address - Fax:602-978-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WCKHBMedicare ID - Type Unspecified