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General NPI Number Information
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NPI Number | 1457416414
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Entity Type | Organization
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Legal Business Name | DESERT PAIN AND REHAB SPECIALISTS
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 11047 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85029
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Country | US
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Telephone | 602-944-2222
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Fax | 602-331-2499
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Provider Business Mailing Address
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Address Line | 11047 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85029-4816
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Country | US
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Telephone | 602-944-2222
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Fax | 602-331-2499
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. HERBERT DONALD GOODMAN
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Credential | M.D.
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Telephone | 602-944-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3984
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 11336
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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