Healthcare Provider Details

I. General information

NPI: 1609073865
Provider Name (Legal Business Name): DESTIN EDWARD HILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 E VIA DE VENTURA BLVD STE 201
SCOTTSDALE AZ
85258-3358
US

IV. Provider business mailing address

PO BOX 271429
SALT LAKE CITY UT
84127-1429
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-3744
  • Fax:
Mailing address:
  • Phone: 602-772-3794
  • Fax: 480-422-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40602
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number40602
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number85471
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: