Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3679 | AZ |
Y | 103TC0700X | Clinical Psychologist | 3679 | AZ |
NPI | 1003920745 |
---|---|
Provider Name | David J Mcintyre |
First Address | Tempe, AZ 85282-7052 |
Second Address | Tempe, AZ 85282-7052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 12/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
955619 | (05) | AZ |