Healthcare Provider Details

I. General information

NPI: 1558629550
Provider Name (Legal Business Name): DANIEL STEVEN CHURGIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 E BROADWAY RD STE 106
MESA AZ
85206-6101
US

IV. Provider business mailing address

6262 E BROADWAY RD STE 106
MESA AZ
85206-6101
US

V. Phone/Fax

Practice location:
  • Phone: 480-482-7100
  • Fax: 480-566-0280
Mailing address:
  • Phone: 480-482-7100
  • Fax: 480-566-0280

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 StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number55406
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number55406
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: