Healthcare Provider Details

I. General information

NPI: 1588654560
Provider Name (Legal Business Name): DESERT WEST OBSTETRICS & GYNECOLOGY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 W THUNDERBIRD RD
GLENDALE AZ
85306-3721
US

IV. Provider business mailing address

6678 W THUNDERBIRD RD # 100
GLENDALE AZ
85306-3721
US

V. Phone/Fax

Practice location:
  • Phone: 602-678-1500
  • Fax: 602-978-0409
Mailing address:
  • Phone: 602-678-1500
  • Fax: 602-978-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY FOWLER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 602-978-1500