MEDICARE: DR. DAVID HIRSCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	11144	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518167733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID HIRSCH M.D.

Provider Business Mailing Address
First Line	:	602 W OCOTILLO RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 W OCOTILLO RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1137
Country	:	US
Telephone Number	:	602-319-0393
Fax Number	:	602-235-9133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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