Basic Information
| Provider Information | |||||||||
| NPI: | 1558823815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANNER | ||||||||
| FirstName: | PAIGE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208313 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753208313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207775030 | ||||||||
| FaxNumber: | 5205094496 | ||||||||
| Practice Location | |||||||||
| Address1: | 10214 N TATUM BLVD STE B300 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850284233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029540777 | ||||||||
| FaxNumber: | 6029546843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2019 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 1041 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 390200000X | 41000387A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 213ES0103X | 1041 | AZ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.