Healthcare Provider Details

I. General information

NPI: 1629399753
Provider Name (Legal Business Name): DARREN E SHOBE P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E SKY HARBOR CIR N STE 150
PHOENIX AZ
85034-3410
US

IV. Provider business mailing address

953 E BUCKINGHAM AVE
GILBERT AZ
85297-1798
US

V. Phone/Fax

Practice location:
  • Phone: 602-244-9500
  • Fax: 602-244-9543
Mailing address:
  • Phone: 480-789-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06817
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5379
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: