Healthcare Provider Details

I. General information

NPI: 1861928749
Provider Name (Legal Business Name): STEPHANIE DANIEL MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W REX ALLEN DR
WILLCOX AZ
85643-1009
US

IV. Provider business mailing address

16772 W BELL RD STE 110-127
SURPRISE AZ
85374-9702
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52709
License Number StateAZ

VIII. Authorized Official

Name: STEPHANIE DANIEL
Title or Position: SOLE OWNER
Credential: MD
Phone: 602-341-0904