Healthcare Provider Details

I. General information

NPI: 1962989244
Provider Name (Legal Business Name): DESERET MEDICAL ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 S KINGS RANCH RD STE 1
GOLD CANYON AZ
85118
US

IV. Provider business mailing address

6410 S KINGS RANCH RD STE 1
GOLD CANYON AZ
85118-7352
US

V. Phone/Fax

Practice location:
  • Phone: 480-981-3000
  • Fax: 480-325-3614
Mailing address:
  • Phone: 480-761-2500
  • Fax: 480-288-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT C ALLEN
Title or Position: OWNER
Credential: MD
Phone: 480-761-2500