Healthcare Provider Details

I. General information

NPI: 1043525314
Provider Name (Legal Business Name): DUSTIN DOYLE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD STE G700
GLENDALE AZ
85306-4673
US

IV. Provider business mailing address

5750 W THUNDERBIRD RD STE G700
GLENDALE AZ
85306-4673
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3600
  • Fax: 602-938-0400
Mailing address:
  • Phone: 602-938-3600
  • Fax: 602-938-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0777
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: