Healthcare Provider Details

I. General information

NPI: 1609977057
Provider Name (Legal Business Name): PERMINDER DUTT VAID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/11/2024
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 W INDIAN SCHOOL RD SUITE # C
PHOENIX AZ
85033
US

IV. Provider business mailing address

6524 W INDIAN SCHOOL RD #C
PHOENIX AZ
85033-3329
US

V. Phone/Fax

Practice location:
  • Phone: 623-247-7409
  • Fax:
Mailing address:
  • Phone: 623-247-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28603
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: