Basic Information
| Provider Information | |||||||||
| NPI: | 1588654560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERT WEST OBSTETRICS & GYNECOLOGY LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6678 W THUNDERBIRD RD # 100 | ||||||||
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| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853063721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026781500 | ||||||||
| FaxNumber: | 6029780409 | ||||||||
| Practice Location | |||||||||
| Address1: | 6678 W THUNDERBIRD RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853063721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026781500 | ||||||||
| FaxNumber: | 6029780409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOWLER | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6029781500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.