1578617262 NPI number — DAVID N. FLIEGER, MD, PC

Table of content: (NPI 1578617262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578617262 NPI number — DAVID N. FLIEGER, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID N. FLIEGER, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578617262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6542 E CARONDELET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85710-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-296-6204
Provider Business Mailing Address Fax Number:
520-296-3463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6542 E CARONDELET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85710-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-296-6204
Provider Business Practice Location Address Fax Number:
520-296-3463
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLIEGER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-296-6204

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD7439 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0399320 . This is a "BCBSAZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 221169 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com