Provider Demographics
NPI:1598141848
Name:FREDERICK G. DETTMANN, M.D.
Entity type:Organization
Organization Name:FREDERICK G. DETTMANN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:GUSTAV
Authorized Official - Last Name:DETTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-481-3076
Mailing Address - Street 1:4801 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1143
Mailing Address - Country:US
Mailing Address - Phone:480-481-3076
Mailing Address - Fax:480-481-9208
Practice Address - Street 1:4801 N 68TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1143
Practice Address - Country:US
Practice Address - Phone:480-481-3076
Practice Address - Fax:480-481-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25333261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch