Basic Information
| Provider Information | |||||||||
| NPI: | 1053625558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEUBLEIN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23735 S STONEY LAKE DR | ||||||||
| Address2: | |||||||||
| City: | SUN LAKES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852486144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802312441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 N SCOTTSDALE RD STE 130 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852515649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804255000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2010 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 4663 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 551229 | 05 | AZ | MEDICAID |