Provider Demographics
NPI:1144225426
Name:DESERT TRAUMA SURGEONS, INC
Entity type:Organization
Organization Name:DESERT TRAUMA SURGEONS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-323-6313
Mailing Address - Street 1:380 E PASEO EL MIRADOR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4842
Mailing Address - Country:US
Mailing Address - Phone:760-323-6316
Mailing Address - Fax:760-323-6531
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-323-6311
Practice Address - Fax:760-323-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA461362086S0127X
CAA438662086S0127X
174400000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0060670Medicaid
CAGR0060670Medicaid
CAZZZ44270ZMedicare ID - Type Unspecified