Healthcare Provider Details

I. General information

NPI: 1548506983
Provider Name (Legal Business Name): VALLEY COLON & RECTAL SURGICAL SPECIALIST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD SUITE #222
SCOTTSDALE AZ
85251-5648
US

IV. Provider business mailing address

3501 N SCOTTSDALE RD SUITE #222
SCOTTSDALE AZ
85251-5648
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-3533
  • Fax: 480-947-3531
Mailing address:
  • Phone: 480-947-3533
  • Fax: 480-947-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number005056
License Number StateAZ

VIII. Authorized Official

Name: MS. SUSAN A GARAND
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 480-947-3533