Provider Demographics
NPI:1760870919
Name:DESERT ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:DESERT ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAURA A KNECHT MD
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-258-9955
Mailing Address - Street 1:2200 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1401
Mailing Address - Country:US
Mailing Address - Phone:602-258-9955
Mailing Address - Fax:602-258-9933
Practice Address - Street 1:2200 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1401
Practice Address - Country:US
Practice Address - Phone:602-258-9955
Practice Address - Fax:602-258-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31996207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ236516Medicaid
AZ236516Medicaid