Provider Demographics
NPI:1982863593
Name:DEROSE, JOSEPH AUGUSTINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:AUGUSTINE
Last Name:DEROSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9767 N 91ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5086
Mailing Address - Country:US
Mailing Address - Phone:480-629-5903
Mailing Address - Fax:480-629-8498
Practice Address - Street 1:9767 N 91ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5086
Practice Address - Country:US
Practice Address - Phone:480-629-5903
Practice Address - Fax:480-629-8498
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ321213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist