Organization Active NPI

Mesa Ear Nose and Throat PC

  • Otolaryngology Physician
  • Gilbert, AZ
National Provider Identifier
1770640930
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD18540 Issued in AZ
Legal business name
MESA EAR NOSE AND THROAT PC
Practice address
726 N Greenfield Rd # 101
Gilbert, AZ 85234-5012
Phone
(480) 833-8620
NPI assigned
Jan 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas James Ketterer, M.D.
Title
President
Phone
(480) 833-8620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X MD18540 AZ Primary

Addresses

Primary practice location

726 N Greenfield Rd # 101
Gilbert, AZ 85234-5012

Mailing address

726 N Greenfield Rd # 101
Gilbert, AZ 85234-5012
Phone (480) 833-8620

National Provider Directory

National Provider Directory

Locations

560 W Brown Rd
Ste 1008
Mesa, AZ 85201
Phone (480) 833-8620

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770640930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 N GREENFIELD RD # 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852345012",
            "telephone_number": "480-833-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 N GREENFIELD RD # 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852345012",
            "telephone_number": "480-833-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA EAR NOSE AND THROAT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KETTERER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-833-8620",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "AZ",
            "license": "MD18540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.