=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982646097
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL J ORRIS D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 08/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1855 E. SOUTHERN AVENUE
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-5894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-829-6100
-----------------------------------------------------
Fax | 480-446-7602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1855 E. SOUTHERN AVENUE
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-5894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-829-6100
-----------------------------------------------------
Fax | 480-446-7602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RB0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 4275
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 4275
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------