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General NPI Number Information
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NPI Number | 1023293388
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Entity Type | Organization
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Legal Business Name | ARIZONA GASTROENTEROLOGY & THERAPEUTIC ENDOSCOPY PC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 14301 N 87TH ST STE 308
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3686
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Country | US
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Telephone | 602-787-1231
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Fax | 602-787-0021
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Provider Business Mailing Address
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Address Line | 15560 N FRANK LLOYD WRIGHT BLVD STE B4 BOX 415
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2091
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Country | US
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Telephone | 602-787-1231
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Fax | 602-787-0021
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEREK LANDAN
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Credential | MD
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Telephone | 602-787-1231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 28634
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License Number State | AZ
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