Provider Demographics
NPI:1497092696
Name:AUTH, DEVON J (PA)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:J
Last Name:AUTH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 E LOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10330 N SCOTTSDALE RD STE 25
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-1427
Practice Address - Country:US
Practice Address - Phone:480-825-7496
Practice Address - Fax:480-878-4153
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z165332OtherMEDICARE PTAN
AZ787705Medicaid
Z158179OtherMEDICARE PTAN