=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649411778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESERT SPINE AND SPORTS PHYSICIANS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2009
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 N 24TH ST STE 210
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-6536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-840-0681
-----------------------------------------------------
Fax | 602-957-1570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 N 24TH ST STE 210
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-6536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-840-0681
-----------------------------------------------------
Fax | 602-957-1570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. BRAD STEVEN SOROSKY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 602-840-0681
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 33710
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 33710
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 33710
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------