| Doctor Name: | DR. FREDERICK GUSTAV DETTMANN |
| NPI Number: | 1003280298 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 25333 |
| Business Practice Address: | 4801 N 68th St Scottsdale, AZ - 852511143 |
| Business Phone Number: | 4804813076 |
| Business Fax Number: | 4804819208 |
| Mailing Address: | 4801 N 68th St, SCOTTSDALE |
| State: | AZ |
| Postal Code: | 852511143 |
| Phone Number: | 4804813076 |
| Fax Number: | 4804819208 |
| NPI Enumeration Date: | 11/25/2015 |
| NPI Last Update Date: | 11/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0006X |
| License Number: | 25333 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Fertility Facility |
| Taxonomy Definition: | A fertility facility, which may be licensed, registered, or certified in some states, that is not hospital-based, where services are provided at a fixed specific location. An Ambulatory Fertility Facility does not provide overnight accommodations. The following fertility procedures may be performed at an Ambulatory Fertility Facility: In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Embryo Transfer-Thaw (ET-T), Zygote Intrafallopian Transfer (ZIFT), Donor OOCYTE (DO) |