Healthcare Provider Details

I. General information

NPI: 1033188909
Provider Name (Legal Business Name): DESERT FOOT SURGEONS P L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE SUITE 206
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

2222 E HIGHLAND AVE SUITE 206
PHOENIX AZ
85016-4872
US

V. Phone/Fax

Practice location:
  • Phone: 602-995-1169
  • Fax: 602-995-7155
Mailing address:
  • Phone: 602-995-1169
  • Fax: 602-995-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0426
License Number StateAZ

VIII. Authorized Official

Name: DR. STEPHEN MICHAEL GELLER
Title or Position: OWNER
Credential: DPM
Phone: 602-995-1169