Provider Demographics
NPI:1801926324
Name:DESERT GASTROENTEROLOGY ASSOCIATES
Entity type:Organization
Organization Name:DESERT GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEDAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOKUOLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-255-5900
Mailing Address - Street 1:2625 WIGWAM PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7326
Mailing Address - Country:US
Mailing Address - Phone:702-255-5900
Mailing Address - Fax:702-255-5980
Practice Address - Street 1:2625 WIGWAM PKWY STE 112
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7326
Practice Address - Country:US
Practice Address - Phone:702-255-5900
Practice Address - Fax:702-255-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5306207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty