Provider Demographics
NPI:1750556163
Name:SPINE & ORTHOPEDIC SPECIALISTS, PLLC
Entity type:Organization
Organization Name:SPINE & ORTHOPEDIC SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOERR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-353-0446
Mailing Address - Street 1:PO BOX 13537
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-3537
Mailing Address - Country:US
Mailing Address - Phone:480-353-0446
Mailing Address - Fax:877-715-6428
Practice Address - Street 1:20401 N 73RD ST
Practice Address - Street 2:SUITE 255
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4147
Practice Address - Country:US
Practice Address - Phone:480-353-0446
Practice Address - Fax:877-715-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6642230001Medicare NSC
AZ122854Medicare PIN