Healthcare Provider Details

I. General information

NPI: 1992371728
Provider Name (Legal Business Name): ALBERT DE RIDDER HARMSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date: 03/31/2023
Reactivation Date: 04/21/2023

III. Provider practice location address

10238 E HAMPTON AVE STE 506
MESA AZ
85209-3321
US

IV. Provider business mailing address

10238 E HAMPTON AVE STE 506
MESA AZ
85209-3321
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-7546
  • Fax: 480-833-8313
Mailing address:
  • Phone: 480-834-7546
  • Fax: 480-833-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: