Basic Information
| Provider Information | |||||||||
| NPI: | 1427117886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEGAL | ||||||||
| FirstName: | DMITRI | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10835 N 25TH AVE | ||||||||
| Address2: | STE 240 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850293458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022462584 | ||||||||
| FaxNumber: | 6022462566 | ||||||||
| Practice Location | |||||||||
| Address1: | 10835 N 25TH AVE | ||||||||
| Address2: | STE 240 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850294751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022462584 | ||||||||
| FaxNumber: | 6022469645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 08/11/2017 | ||||||||
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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 | 2085R0202X | 005238 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.