Healthcare Provider Details

I. General information

NPI: 1508956798
Provider Name (Legal Business Name): STEPHEN DAHMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 E SUNRISE DR STE 100
TUCSON AZ
85750-0733
US

IV. Provider business mailing address

6860 E SUNRISE DR STE 100
TUCSON AZ
85750-0733
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-1042
  • Fax:
Mailing address:
  • Phone: 520-694-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number239225
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number72250
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: