Provider Demographics
NPI:1043436041
Name:MCCANDLESS, LINDA (DO)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MCCANDLESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14539 W INDIAN SCHOOL RD STE 800
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9279
Mailing Address - Country:US
Mailing Address - Phone:623-882-3364
Mailing Address - Fax:623-882-3367
Practice Address - Street 1:14539 W INDIAN SCHOOL RD STE 800
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9279
Practice Address - Country:US
Practice Address - Phone:623-882-3364
Practice Address - Fax:623-882-3367
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0055852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005585OtherAZ LICENSE
KS05-28420OtherKS LICENSE
KS200300359AMedicaid
KS200300359AMedicaid
AZBM4925129OtherDEA