Individual
DR. MARVIN GERALD RISKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 S DOBSON RD STE D27, CHANDLER, AZ 85224-5691
(804) 960-0000
(480) 496-7325
Mailing address
9590 E IRONWOOD SQUARE DR STE 125, SCOTTSDALE, AZ 85258-4583
(480) 455-3000
(866) 819-6115
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
21421
AZ
207R00000X
Internal Medicine Physician
Primary
21421
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194902
—
AZ
01
—
Z211816
MEDICARE PTAN
AZ
Enumeration date
09/29/2006
Last updated
05/23/2019
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