Healthcare Provider Details

I. General information

NPI: 1750556163
Provider Name (Legal Business Name): SPINE & ORTHOPEDIC SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20401 N 73RD ST SUITE 255
SCOTTSDALE AZ
85255-4147
US

IV. Provider business mailing address

PO BOX 13537
SCOTTSDALE AZ
85267-3537
US

V. Phone/Fax

Practice location:
  • Phone: 480-353-0446
  • Fax: 877-715-6428
Mailing address:
  • Phone: 480-353-0446
  • Fax: 877-715-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD M DOERR
Title or Position: PHYSICIAN
Credential: MD
Phone: 480-353-0446