Organization
DESERT SPINE INSTITUTE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN F HERMENAU M.D. (PRESIDENT)
(928) 247-9714
Entity
Organization
Contact information
Practice address
2851 S AVENUE B, SUITE 2401, YUMA, AZ 85364-7726
(928) 247-9714
(928) 247-9718
Mailing address
2851 S AVENUE B STE 2401, YUMA, AZ 85364-7759
(928) 247-9714
(928) 247-9718
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
541871
—
AZ
Enumeration date
08/09/2010
Last updated
11/05/2014
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