Provider Demographics
NPI:1619107547
Name:DESERT GASTROENTEROLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DESERT GASTROENTEROLOGY ASSOCIATES PLLC
Other - Org Name:DESERT GI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIV
Authorized Official - Middle Name:K
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-353-2000
Mailing Address - Street 1:1520 S DOBSON RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4725
Mailing Address - Country:US
Mailing Address - Phone:480-353-2000
Mailing Address - Fax:480-353-2185
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 212
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4725
Practice Address - Country:US
Practice Address - Phone:480-353-2000
Practice Address - Fax:480-353-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32753207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH67779Medicare UPIN