Healthcare Provider Details

I. General information

NPI: 1831765585
Provider Name (Legal Business Name): MICHAEL E MCDERMOTT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E HIGHWAY 90
SIERRA VISTA AZ
85635-9110
US

IV. Provider business mailing address

3371 VILLAGE DR
SIERRA VISTA AZ
85635-4256
US

V. Phone/Fax

Practice location:
  • Phone: 520-263-2000
  • Fax:
Mailing address:
  • Phone: 480-242-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number011061
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011061
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: