Provider Demographics
NPI:1528025004
Name:DEYDEN, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:DEYDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1520 S DOBSON RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4725
Mailing Address - Country:US
Mailing Address - Phone:480-833-7441
Mailing Address - Fax:480-833-2527
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 214
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4725
Practice Address - Country:US
Practice Address - Phone:480-833-7441
Practice Address - Fax:480-833-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ10408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962512004OtherCOPORATE NPI
1962512004OtherCORPORATE NPI
AZ230326Medicaid
AZ756021641OtherRR MEDICARE
AZAZ0012280OtherBCBS AZ
AZAZ0248OtherHEALTHNET OF AZ