Individual
DR. CHERI DIANE DERSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4730 E INDIAN SCHOOL RD, SUITE 211, PHOENIX, AZ 85018-5441
(602) 354-3491
Mailing address
6131 E CALLE ROSA, SCOTTSDALE, AZ 85251-4222
(480) 874-5835
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
31114
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77634604
—
AZ
Enumeration date
08/03/2006
Last updated
10/20/2007
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