Provider Demographics
NPI:1124674288
Name:ARIZONA DESERT EAR NOSE & THROAT SPECIALIST, PLLC
Entity type:Organization
Organization Name:ARIZONA DESERT EAR NOSE & THROAT SPECIALIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHAROUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-512-4199
Mailing Address - Street 1:13555 W MCDOWELL RD STE 209
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2628
Mailing Address - Country:US
Mailing Address - Phone:623-209-7771
Mailing Address - Fax:623-512-4178
Practice Address - Street 1:13555 W MCDOWELL RD STE 209
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2628
Practice Address - Country:US
Practice Address - Phone:623-512-4358
Practice Address - Fax:623-512-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty