Provider Demographics
NPI:1841243037
Name:DESERT VALLEY RADIOLOGY, PLC
Entity Type:Organization
Organization Name:DESERT VALLEY RADIOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:602-867-0404
Mailing Address - Street 1:4045 E BELL RD
Mailing Address - Street 2:STE. #143
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:602-867-0404
Mailing Address - Fax:602-788-0893
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:STE. #143
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-867-0404
Practice Address - Fax:602-788-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1Z7050OtherHEALTHNET
AZAZ0266130OtherBLUD CROSS BLUE SHIELD
AZAZ0266130OtherBLUD CROSS BLUE SHIELD