Organization
DIRECT2MD
Active
Organization
DIRECT2MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADELLA CORDOVA (CREDENTIALING MANAGER)
(623) 326-1055
Entity
Organization
Contact information
Practice address
5656 E ORANGE BLOSSOM LN STE 5, PHOENIX, AZ 85018-8139
(602) 601-7430
(602) 601-7428
Mailing address
5656 E ORANGE BLOSSOM LN STE 5, PHOENIX, AZ 85018-8139
(602) 601-7430
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3162
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3162
STATE LICENSE
AZ
Enumeration date
08/17/2018
Last updated
08/17/2018
Update your record
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