Healthcare Provider Details

I. General information

NPI: 1093896318
Provider Name (Legal Business Name): DAVID EDWIN STETSON PHD, PSYCHOL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S 1ST AVE
SAFFORD AZ
85546-2103
US

IV. Provider business mailing address

489 N ARROYO BLVD
NOGALES AZ
85621-2644
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-4550
  • Fax: 928-428-4588
Mailing address:
  • Phone: 520-287-4713
  • Fax: 520-287-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberPSYCHOL 3521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: