Provider Demographics
NPI:1114909751
Name:PAULL, DANA M (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:PAULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 E 2ND ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5600
Mailing Address - Country:US
Mailing Address - Phone:480-707-7672
Mailing Address - Fax:480-707-7673
Practice Address - Street 1:7301 E 2ND ST
Practice Address - Street 2:SUITE 311
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5600
Practice Address - Country:US
Practice Address - Phone:480-707-7672
Practice Address - Fax:480-707-7673
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ16029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ275942-02Medicaid
D37429Medicare UPIN
AZZWMBRX01Medicare PIN