Healthcare Provider Details

I. General information

NPI: 1093112427
Provider Name (Legal Business Name): DORIE M. ANDERSSOHN D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 W BETHANY HOME RD
PHOENIX AZ
85017-2102
US

IV. Provider business mailing address

2524 W BETHANY HOME RD
PHOENIX AZ
85017-2102
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-1657
  • Fax: 602-242-5573
Mailing address:
  • Phone: 602-242-1657
  • Fax: 602-242-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number4007
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: