Provider Demographics
NPI:1831492784
Name:UNIVERSAL DIAGNOSTIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:UNIVERSAL DIAGNOSTIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MERZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-451-8880
Mailing Address - Street 1:9449 N 90TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5063
Mailing Address - Country:US
Mailing Address - Phone:480-451-8880
Mailing Address - Fax:480-451-8886
Practice Address - Street 1:9449 N 90TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5063
Practice Address - Country:US
Practice Address - Phone:480-451-8880
Practice Address - Fax:480-451-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2710208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2710OtherMEDICAL LICENSE