Basic Information
| Provider Information | |||||||||
| NPI: | 1497903389 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERT CARDIOVASCULAR GROUP LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30370 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857510370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207220777 | ||||||||
| FaxNumber: | 5202909713 | ||||||||
| Practice Location | |||||||||
| Address1: | 2530 E WILCOX DR | ||||||||
| Address2: | |||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204170586 | ||||||||
| FaxNumber: | 5204174207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | GLADDING | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5204170586 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 1894 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.