Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 58450 | AZ |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 58450 | AZ |
NPI | 1104473883 |
---|---|
Provider Name | Christopher Desutter |
First Address | Phoenix, AZ 85023-1266 |
Second Address | Phoenix, AZ 85037-3392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2019 |
Last Update Date | 19/08/2019 |