Healthcare Provider Details

I. General information

NPI: 1437440070
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL DIEFENBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E OAK AVE
FLAGSTAFF AZ
86001
US

IV. Provider business mailing address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

V. Phone/Fax

Practice location:
  • Phone: 928-779-7880
  • Fax: 928-913-8801
Mailing address:
  • Phone: 928-213-6235
  • Fax: 928-213-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number53879
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number53879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: