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General NPI Number Information
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NPI Number | 1982735031
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Entity Type | Organization
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Legal Business Name | DESERT HORIZON MEDICAL GROUP
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 2501 E SOUTHERN AVE SUITE 4
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City | TEMPE
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State | AZ
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Zip | 85282-7669
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Country | US
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Telephone | 520-421-1122
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Fax | 520-421-0751
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Provider Business Mailing Address
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Address Line | PO BOX 13410
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City | CHANDLER
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State | AZ
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Zip | 85248-0041
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Country | US
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Telephone | 520-421-1122
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Fax | 520-421-0751
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | FREDERICK STACK
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Credential | MD
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Telephone | 520-421-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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