Healthcare Provider Details

I. General information

NPI: 1609257062
Provider Name (Legal Business Name): MICHAEL DYTON PRIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD FL 2
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

755 E MCDOWELL RD FL 2
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-3550
  • Fax: 602-635-6572
Mailing address:
  • Phone: 602-521-3550
  • Fax: 602-635-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number66227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: