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NPI Code Detail

MEDICARE: CHRISTIAN L DEWALD MD

MEDICARE: CHRISTIAN L DEWALD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician24796AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336138387
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN L DEWALD MD
Provider Business Mailing Address
First Line : 2323 W ROSE GARDEN LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-2530
Country : US
Telephone Number : 623-931-7999
Fax Number : 623-842-5640
Provider Business Practice Location Address
First Line : 5605 W EUGIE AVE STE 110
Second Line :
City : GLENDALE
State : AZ
Zip : 85304-1273
Country : US
Telephone Number : 623-847-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 03/06/2019

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Directions to “ CHRISTIAN L DEWALD MD” Practice Location

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