Healthcare Provider Details

I. General information

NPI: 1013736404
Provider Name (Legal Business Name): MIND AZ, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 E CHANDLER BLVD STE 200
PHOENIX AZ
85048-7651
US

IV. Provider business mailing address

4435 E CHANDLER BLVD STE 200
PHOENIX AZ
85048-7651
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-4458
  • Fax:
Mailing address:
  • Phone: 480-818-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID W DIXON
Title or Position: OWNER
Credential: DO
Phone: 480-818-4458