MEDICARE: MARY M DESCH MD

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	2084P0800X	Psychiatry Physician	25883	AZ

General Provider Information

NPI Number	:	1700986767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M DESCH MD

Provider Business Mailing Address
First Line	:	1037 E MISSOURI AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2663
Country	:	US
Telephone Number	:	602-393-2373
Fax Number	:	602-393-2374

Provider Business Practice Location Address
First Line	:	1037 E MISSOURI AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2663
Country	:	US
Telephone Number	:	602-393-2373
Fax Number	:	602-393-2374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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