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General NPI Number Information
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NPI Number | 1841505302
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Entity Type | Organization
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Legal Business Name | DESERT SPINE INSTITUTE PLLC
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 2851 S AVENUE B SUITE 2401
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City | YUMA
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State | AZ
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Zip | 85364-7726
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Country | US
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Telephone | 928-247-9714
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Fax | 928-247-9718
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Provider Business Mailing Address
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Address Line | 2851 S AVENUE B STE 2401
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City | YUMA
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State | AZ
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Zip | 85364-7759
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Country | US
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Telephone | 928-247-9714
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Fax | 928-247-9718
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAWN F HERMENAU
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Credential | M.D.
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Telephone | 928-247-9714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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