Healthcare Provider Details

I. General information

NPI: 1154708451
Provider Name (Legal Business Name): DOUGLAS DANIEL OPIE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 COLONIA DE SALUD STE 100C
SIERRA VISTA AZ
85635-2485
US

IV. Provider business mailing address

3925 E BRUCE AVE
GILBERT AZ
85234-4450
US

V. Phone/Fax

Practice location:
  • Phone: 520-263-3620
  • Fax:
Mailing address:
  • Phone: 480-296-9232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number008630
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: