Healthcare Provider Details

I. General information

NPI: 1326493768
Provider Name (Legal Business Name): DESERT PRINCESS MEDICAL GRP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD STE 131
SCOTTSDALE AZ
85260-1503
US

IV. Provider business mailing address

8711 E PINNACLE PEAK RD BOX 218
SCOTTSDALE AZ
85255-3517
US

V. Phone/Fax

Practice location:
  • Phone: 480-559-4776
  • Fax: 866-526-7086
Mailing address:
  • Phone: 480-559-4776
  • Fax: 866-526-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number36773
License Number StateAZ

VIII. Authorized Official

Name: RICHARD HAINES DEMIR
Title or Position: PHYSICIAN
Credential: MD
Phone: 480-559-4776