Provider Demographics
NPI:1629399753
Name:SHOBE, DARREN E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:E
Last Name:SHOBE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 E BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1798
Mailing Address - Country:US
Mailing Address - Phone:480-789-2417
Mailing Address - Fax:
Practice Address - Street 1:1818 E SKY HARBOR CIR N STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-3410
Practice Address - Country:US
Practice Address - Phone:602-244-9500
Practice Address - Fax:602-244-9543
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXPA06817363A00000X
AZ5379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281185303Medicaid
TX281185301Medicaid
TX281185302Medicaid
NM29851050Medicaid
TX281185302Medicaid
TX281185303Medicaid
TXTXB127653Medicare PIN