Provider Demographics
NPI:1114956273
Name:CAPAMPANGAN, DAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:J
Last Name:CAPAMPANGAN
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 1:3507 S MERCY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0441
Mailing Address - Country:US
Mailing Address - Phone:480-926-0645
Mailing Address - Fax:480-926-0645
Practice Address - Street 1:3507 S MERCY RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0441
Practice Address - Country:US
Practice Address - Phone:480-926-0644
Practice Address - Fax:480-926-0645
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ374182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ132337Medicare PIN