Provider Demographics
NPI:1578532263
Name:PAUL, DENNIS L II (MS PA C)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:L
Last Name:PAUL
Suffix:II
Gender:M
Credentials:MS PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6567 E CARONDELET DR STE 305
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6160
Mailing Address - Country:US
Mailing Address - Phone:520-881-8400
Mailing Address - Fax:520-881-6563
Practice Address - Street 1:6567 E CARONDELET DR STE 305
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-881-8400
Practice Address - Fax:520-881-6563
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2878363A00000X, 363AS0400X
MO2012002427363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ817926Medicaid
AZ817926Medicaid
P98473Medicare UPIN