Organization
YUMA GASTRO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIVESH R. ANIREDDY M.D. (SECRETARY)
(928) 726-5151
Entity
Organization
Contact information
Practice address
1390 W 16TH ST, YUMA, AZ 85364-4430
(928) 344-4325
(928) 344-3084
Mailing address
1390 W 16TH ST, YUMA, AZ 85364-4430
(928) 344-4325
(928) 344-3084
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529143
—
AZ
Enumeration date
05/20/2010
Last updated
03/28/2017
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