Healthcare Provider Details

I. General information

NPI: 1477589075
Provider Name (Legal Business Name): VALLEY RADIOLOGISTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W ROSE GARDEN LN
PHOENIX AZ
85027-2530
US

IV. Provider business mailing address

2323 W ROSE GARDEN LN
PHOENIX AZ
85027-2530
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-7999
  • Fax: 623-931-5640
Mailing address:
  • Phone: 623-931-7999
  • Fax: 623-931-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. CHRISTIAN L DEWALD
Title or Position: RADIOLOGIST
Credential: MD
Phone: 623-931-7999