Provider Demographics
NPI:1053373100
Name:RIERSON, ROBERT DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:RIERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9868 E SIDEWINDER TRL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-4400
Mailing Address - Country:US
Mailing Address - Phone:480-483-8113
Mailing Address - Fax:480-483-8113
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-839-4915
Practice Address - Fax:602-839-5112
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7662207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ233388Medicaid
AZZ132019Medicare PIN
AZ233388Medicaid