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General NPI Number Information
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NPI Number | 1760870919
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Entity Type | Organization
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Legal Business Name | DESERT ENDOCRINOLOGY LLC
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 2200 N 3RD ST
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City | PHOENIX
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State | AZ
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Zip | 85004-1401
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Country | US
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Telephone | 602-258-9955
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Fax | 602-258-9933
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Provider Business Mailing Address
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Address Line | 2200 N 3RD ST
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City | PHOENIX
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State | AZ
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Zip | 85004-1401
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Country | US
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Telephone | 602-258-9955
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Fax | 602-258-9933
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Authorized Official
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Title or Position | LAURA A KNECHT MD
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Name | LAURA A KNECHT
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Credential | M.D.
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Telephone | 602-258-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 31996
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License Number State | AZ
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