Organization
DESERT HORIZON MEDICAL GROUP
Active
Parent organization
DESERT HORIZON MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
DESERT HORIZON MEDICAL GROUP
Authorized official
MR. FREDERICK STACK DPM (PRESIDENT)
(520) 421-1122
Entity
Organization
Contact information
Practice address
1501 N GILBERT RD, SUITE 207, GILBERT, AZ 85234-2390
(520) 421-1122
(520) 421-0751
Mailing address
1821 N TREKELL RD, SUITE 6, CASA GRANDE, AZ 85222-1705
(520) 421-1122
(520) 421-0751
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH1571
RAILROAD MEDICARE
AZ
Enumeration date
05/16/2008
Last updated
05/16/2008
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