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General NPI Number Information
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NPI Number | 1427154442
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Entity Type | Organization
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Legal Business Name | SOUTHEAST VALLEY OBSTETRICS & GYNECOLOGY PLC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 4566 E INVERNESS AVE SUITE 202
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City | MESA
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State | AZ
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Zip | 85206-4633
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Country | US
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Telephone | 480-464-2101
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Fax | 480-854-4913
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Provider Business Mailing Address
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Address Line | 4566 E INVERNESS AVE SUITE 202
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City | MESA
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State | AZ
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Zip | 85206-4633
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Country | US
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Telephone | 480-464-2101
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Fax | 480-854-4913
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIDNEY E SEMRAD
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Credential | D.O.
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Telephone | 480-464-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2605
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License Number State | AZ
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