Provider Demographics
NPI:1982646097
Name:ORRIS, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ORRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 E. SOUTHERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5894
Mailing Address - Country:US
Mailing Address - Phone:480-829-6100
Mailing Address - Fax:480-446-7602
Practice Address - Street 1:1855 E. SOUTHERN AVENUE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5894
Practice Address - Country:US
Practice Address - Phone:480-829-6100
Practice Address - Fax:480-446-7602
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4275207RB0002X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z2488OtherHEALTHNET OF AZ
AZ044930Medicaid
AZAZ0786380OtherAZ BCBS
AZ104650Medicare ID - Type Unspecified
AZ044930Medicaid