Provider Demographics
NPI:1427154442
Name:SOUTHEAST VALLEY OBSTETRICS & GYNECOLOGY PLC
Entity type:Organization
Organization Name:SOUTHEAST VALLEY OBSTETRICS & GYNECOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEMRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-464-2101
Mailing Address - Street 1:4566 E INVERNESS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4633
Mailing Address - Country:US
Mailing Address - Phone:480-464-2101
Mailing Address - Fax:480-854-4913
Practice Address - Street 1:4566 E INVERNESS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4633
Practice Address - Country:US
Practice Address - Phone:480-464-2101
Practice Address - Fax:480-854-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2605207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75322OtherMEDICARE
AZ75321Medicare ID - Type Unspecified