Healthcare Provider Details

I. General information

NPI: 1619962776
Provider Name (Legal Business Name): EDWARD JOHN DOHRING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 N 90TH PL
SCOTTSDALE AZ
85258-5067
US

IV. Provider business mailing address

9735 N 90TH PL
SCOTTSDALE AZ
85258-5067
US

V. Phone/Fax

Practice location:
  • Phone: 602-953-9500
  • Fax: 602-953-1782
Mailing address:
  • Phone: 602-953-9500
  • Fax: 602-953-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number21817
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: