Healthcare Provider Details

I. General information

NPI: 1477797710
Provider Name (Legal Business Name): DESERT VALLEY GASTROENTEROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 E BASELINE RD SUITE 001
GILBERT AZ
85234-2727
US

IV. Provider business mailing address

3921 E BASELINE RD SUITE 001
GILBERT AZ
85234-2727
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-6405
  • Fax: 480-306-6409
Mailing address:
  • Phone: 480-306-6405
  • Fax: 480-306-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36236
License Number StateAZ

VIII. Authorized Official

Name: DR. STEVEN C KAISER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 480-306-6405