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General NPI Number Information
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NPI Number | 1093518995
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Entity Type | Organization
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Legal Business Name | CENTRAL ARIZONA GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 3638 E SOUTHERN AVE STE C108
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City | MESA
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State | AZ
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Zip | 85206-2564
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Country | US
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Telephone | 480-834-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 8704 E HANNIBAL ST
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City | MESA
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State | AZ
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Zip | 85207-4110
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Country | US
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Telephone | 480-252-5477
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Fax |
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Authorized Official
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Title or Position | OWNER REPRESENTATIVE
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Name | DARAS ADAMS
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Credential |
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Telephone | 480-252-5477
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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 |
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License Number State |
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