Provider Demographics
NPI:1417912700
Name:FLEWELLING, DALE WAYNE (NP-C)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:WAYNE
Last Name:FLEWELLING
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 W THOMAS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3354
Mailing Address - Country:US
Mailing Address - Phone:623-792-1600
Mailing Address - Fax:602-464-7427
Practice Address - Street 1:9305 W THOMAS RD STE 500
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3354
Practice Address - Country:US
Practice Address - Phone:623-792-1600
Practice Address - Fax:602-464-7427
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1417912700208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120974Medicare UPIN