Provider Demographics
NPI:1619311446
Name:DESERT SPINE CENTER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DESERT SPINE CENTER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KORSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-354-6489
Mailing Address - Street 1:3760 CONVOY ST STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3743
Mailing Address - Country:US
Mailing Address - Phone:858-715-8444
Mailing Address - Fax:858-715-8324
Practice Address - Street 1:2281 W 24TH ST STE 5
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6197
Practice Address - Country:US
Practice Address - Phone:928-276-9930
Practice Address - Fax:858-715-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46913207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty