Healthcare Provider Details

I. General information

NPI: 1720415508
Provider Name (Legal Business Name): DEMIR MEDICAL GROUP SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 N MCCLINTOCK DR # 104
CHANDLER AZ
85226-3767
US

IV. Provider business mailing address

8711 E PINNACLE PEAK RD 218
SCOTTSDALE AZ
85255-3517
US

V. Phone/Fax

Practice location:
  • Phone: 480-559-4776
  • Fax: 866-526-7086
Mailing address:
  • Phone: 480-559-4776
  • Fax: 866-526-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36773
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number36773
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number36773
License Number StateAZ

VIII. Authorized Official

Name: RICHARD HAINES DEMIR
Title or Position: PROVIDER
Credential: M.D.
Phone: 480-559-4776