Provider Demographics
NPI:1922011436
Name:LERSCH, DAVID RALPH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RALPH
Last Name:LERSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 N 15TH ST
Mailing Address - Street 2:#130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4347
Mailing Address - Country:US
Mailing Address - Phone:602-861-1611
Mailing Address - Fax:602-371-8929
Practice Address - Street 1:7600 N 15TH ST
Practice Address - Street 2:#130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4347
Practice Address - Country:US
Practice Address - Phone:602-861-1611
Practice Address - Fax:602-371-8929
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics