Individual
ROCKY RAY DESWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
HWY 264 MILE POST 388, POLACCA, AZ 86042-4000
(928) 737-6232
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
891542
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
Enumeration date
02/09/2018
Last updated
02/09/2018
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