Provider Demographics
NPI:1558823815
Name:DANNER, PAIGE (DPM)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:DANNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208313
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8313
Mailing Address - Country:US
Mailing Address - Phone:520-777-5030
Mailing Address - Fax:520-509-4496
Practice Address - Street 1:10214 N TATUM BLVD STE B300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4233
Practice Address - Country:US
Practice Address - Phone:602-954-0777
Practice Address - Fax:602-954-6843
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1041213E00000X, 213ES0103X
IN41000387A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program