MEDICARE: DESERT PEDIATRIC SPECIALTY CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	22057	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053303867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT PEDIATRIC SPECIALTY CARE PC

Provider Business Mailing Address
First Line	:	515 E CAREFREE HWY
Second Line	:	PMB 1126
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8839
Country	:	US
Telephone Number	:	623-465-9866
Fax Number	:

Provider Business Practice Location Address
First Line	:	43220 N 24TH ST
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-8626
Country	:	US
Telephone Number	:	623-465-9866
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT M HURWITZ
Credential	:	MD
Telephone Number	:	623-465-9866

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/31/2011

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