Healthcare Provider Details

I. General information

NPI: 1881892081
Provider Name (Legal Business Name): DEBARROS SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E SOUTHERN AVE
TEMPE AZ
85282-5894
US

IV. Provider business mailing address

1855 E SOUTHERN AVE
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 TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33625
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN J DEBARROS
Title or Position: SURGEON
Credential: M.D.
Phone: 480-829-6100