Healthcare Provider Details

I. General information

NPI: 1366472680
Provider Name (Legal Business Name): MATTHEW R DAAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N MAIN ST
TUBA CITY AZ
86045-0600
US

IV. Provider business mailing address

TUBA CITY REGIONAL HEALTHCARE CORPORTATION 167 N. MAIN ST.
TUBA CITY AZ
86045
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2501
  • Fax: 904-542-7836
Mailing address:
  • Phone: 928-283-2501
  • Fax: 904-542-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52170
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: