Healthcare Provider Details

I. General information

NPI: 1649244609
Provider Name (Legal Business Name): SHELLY RAE MESSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6239 E BROWN RD BLDG 2 STE 112
MESA AZ
85205
US

IV. Provider business mailing address

6239 E BROWN RD BLDG 2 STE 112
MESA AZ
85205
US

V. Phone/Fax

Practice location:
  • Phone: 480-854-2676
  • Fax: 480-854-3618
Mailing address:
  • Phone: 480-854-2676
  • Fax: 480-854-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28636
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: