Provider Demographics
NPI:1649244609
Name:MESSER, SHELLY RAE (MD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RAE
Last Name:MESSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6239 E BROWN RD
Mailing Address - Street 2:BLDG 2 STE 112
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-854-2676
Mailing Address - Fax:480-854-3618
Practice Address - Street 1:6239 E BROWN RD
Practice Address - Street 2:BLDG 2 STE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-854-2676
Practice Address - Fax:480-854-3618
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28636207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
561929OtherAHCCCS
AZ73113Medicare ID - Type Unspecified
561929OtherAHCCCS