# DESERT HORIZON MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DESERT HORIZON MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1518124700
- **Legal business name:** DESERT HORIZON MEDICAL GROUP
- **Authorized official:** MR. FREDERICK STACK DPM (PRESIDENT)
- **Authorized official phone:** (520) 421-1122

## Contact information

- **Practice address:** 1501 N GILBERT RD, SUITE 207, GILBERT, AZ 85234-2390
- **Practice address phone:** (520) 421-1122
- **Practice address fax:** (520) 421-0751
- **Mailing address:** 1821 N TREKELL RD, SUITE 6, CASA GRANDE, AZ 85222-1705
- **Mailing address phone:** (520) 421-1122
- **Mailing address fax:** (520) 421-0751

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 05/16/2008
- **Last updated:** 05/16/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CH1571 | RAILROAD MEDICARE | AZ |