Healthcare Provider Details

I. General information

NPI: 1235427709
Provider Name (Legal Business Name): DESERT SPINE AND SCOLIOSIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 E INVERNESS AVE SUITE 208
MESA AZ
85206-4633
US

IV. Provider business mailing address

4566 E INVERNESS AVE SUITE 208
MESA AZ
85206-4633
US

V. Phone/Fax

Practice location:
  • Phone: 480-993-1300
  • Fax: 480-993-1335
Mailing address:
  • Phone: 480-993-1300
  • Fax: 480-993-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number42500
License Number StateAZ

VIII. Authorized Official

Name: DR. RAFATH ULLAH BAIG
Title or Position: PRESIDENT
Credential: MD
Phone: 480-993-1300