Healthcare Provider Details

I. General information

NPI: 1467449298
Provider Name (Legal Business Name): ENTEGRITY EAR NOSE & THROAT SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD SUITE 275
PHOENIX AZ
85028-3091
US

IV. Provider business mailing address

11209 N TATUM BLVD SUITE 275
PHOENIX AZ
85028-3091
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5090
  • Fax: 602-494-5055
Mailing address:
  • Phone: 602-494-5090
  • Fax: 602-494-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY J DYER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-494-5090