Healthcare Provider Details

I. General information

NPI: 1578247383
Provider Name (Legal Business Name): CHRISTOPHER DANGERFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD STE F1
GLENDALE AZ
85306-4652
US

IV. Provider business mailing address

655 S DOBSON RD
CHANDLER AZ
85224-5667
US

V. Phone/Fax

Practice location:
  • Phone: 480-716-5190
  • Fax: 602-609-2053
Mailing address:
  • Phone: 623-469-5553
  • Fax: 623-469-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: