Provider Demographics
NPI:1790840890
Name:DESERT VIEW FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:DESERT VIEW FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-324-0300
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:SUITE 187
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1675
Mailing Address - Country:US
Mailing Address - Phone:480-324-0300
Mailing Address - Fax:480-603-0786
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:SUITE 187
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1675
Practice Address - Country:US
Practice Address - Phone:480-324-0300
Practice Address - Fax:480-603-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ63819Medicare PIN