Provider Demographics
NPI:1114913175
Name:ABLE, STEPHEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:ABLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69805
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-0022
Mailing Address - Country:US
Mailing Address - Phone:520-797-1826
Mailing Address - Fax:520-797-6975
Practice Address - Street 1:11115 N LA CANADA DR STE 275
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9496
Practice Address - Country:US
Practice Address - Phone:520-797-1826
Practice Address - Fax:520-797-6975
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2019-08-01
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AZ202772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZZ74547Medicare PIN