Provider Demographics
NPI:1275507253
Name:DAITCH, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:DAITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:77 E THOMAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3100
Mailing Address - Country:US
Mailing Address - Phone:602-557-0007
Mailing Address - Fax:602-557-0002
Practice Address - Street 1:20401 N 73RD ST STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4146
Practice Address - Country:US
Practice Address - Phone:480-661-2662
Practice Address - Fax:480-307-9327
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27279208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26899Medicare ID - Type Unspecified
AZG76423Medicare UPIN