Provider Demographics
NPI:1497841423
Name:ALEXANDER, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ALEXANDER
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 1:4350 E CAMELBACK ROAD
Mailing Address - Street 2:SUITE G 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2720
Mailing Address - Country:US
Mailing Address - Phone:602-940-3120
Mailing Address - Fax:602-840-3237
Practice Address - Street 1:4350 E CAMELBACK ROAD
Practice Address - Street 2:SUITE G 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2720
Practice Address - Country:US
Practice Address - Phone:602-940-3120
Practice Address - Fax:602-840-3237
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22842Medicare UPIN
37WCLCT02Medicare ID - Type Unspecified