Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | R74102 | AZ |
Y | 111NI0900X | Internist | R74102 | AZ |
NPI | 1003254566 |
---|---|
Provider Name | Dana Archbold |
First Address | Phoenix, AZ 85006-2612 |
Second Address | Phoenix, AZ 85006-2612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 06/06/2013 |