Healthcare Provider Details

I. General information

NPI: 1255403853
Provider Name (Legal Business Name): DANIEL B HOAG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20715 E OCOTILLO RD STE 102
QUEEN CREEK AZ
85142-6118
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-0987
  • Fax: 480-987-0940
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3582
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: