Basic Information
| Provider Information | |||||||||
| NPI: | 1053793422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST VALLEY INFECTIOUS DISEASES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 W BERYL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850211606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024247967 | ||||||||
| FaxNumber: | 6023714960 | ||||||||
| Practice Location | |||||||||
| Address1: | 14502 W MEEKER BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853755282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235244000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | BADGER | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2163465588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 43063 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.