Healthcare Provider Details

I. General information

NPI: 1487645685
Provider Name (Legal Business Name): KENNETH D PAIGE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 E RIGGS RD #114
SUN LAKES AZ
85248-7760
US

IV. Provider business mailing address

10450 E RIGGS RD #114
SUN LAKES AZ
85248-7760
US

V. Phone/Fax

Practice location:
  • Phone: 480-505-2450
  • Fax: 480-505-2465
Mailing address:
  • Phone: 480-505-2450
  • Fax: 480-505-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: