Provider Demographics
NPI:1023293388
Name:ARIZONA GASTROENTEROLOGY & THERAPEUTIC ENDOSCOPY PC
Entity type:Organization
Organization Name:ARIZONA GASTROENTEROLOGY & THERAPEUTIC ENDOSCOPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-787-1231
Mailing Address - Street 1:15560 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:STE B4 BOX 415
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2091
Mailing Address - Country:US
Mailing Address - Phone:602-787-1231
Mailing Address - Fax:602-787-0021
Practice Address - Street 1:14301 N 87TH ST
Practice Address - Street 2:STE 308
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3686
Practice Address - Country:US
Practice Address - Phone:602-787-1231
Practice Address - Fax:602-787-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28634207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z76848Medicare PIN