Provider Demographics
NPI:1750355970
Name:PALO VERDE PEDIATRICS PLLC
Entity type:Organization
Organization Name:PALO VERDE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DEARDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-733-6500
Mailing Address - Street 1:120 S VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1370
Mailing Address - Country:US
Mailing Address - Phone:480-733-6500
Mailing Address - Fax:480-633-3794
Practice Address - Street 1:120 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1370
Practice Address - Country:US
Practice Address - Phone:480-733-6500
Practice Address - Fax:480-633-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty