Healthcare Provider Details

I. General information

NPI: 1982646097
Provider Name (Legal Business Name): MICHAEL J ORRIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E. SOUTHERN AVENUE
TEMPE AZ
85282-5894
US

IV. Provider business mailing address

1855 E. SOUTHERN AVENUE
TEMPE AZ
85282-5894
US

V. Phone/Fax

Practice location:
  • Phone: 480-829-6100
  • Fax: 480-446-7602
Mailing address:
  • Phone: 480-829-6100
  • Fax: 480-446-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number4275
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4275
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: