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General NPI Number Information
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NPI Number | 1932390796
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Entity Type | Organization
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Legal Business Name | DEIBLER PSYCHIATRIC, PLLC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 2120 W RESERVATION LOOP RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322
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Country | US
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Telephone | 928-567-5231
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Fax |
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Provider Business Mailing Address
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Address Line | 3132 W STEINBECK DR
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City | ANTHEM
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State | AZ
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Zip | 85086-1535
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Country | US
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Telephone | 602-791-1282
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DEREK S DEIBLER
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Credential | MD
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Telephone | 602-791-1282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32333
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License Number State | AZ
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