Provider Demographics
NPI:1659569697
Name:FIFE, DAVID ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:FIFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 S HIGLEY RD STE 114-266
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5454
Mailing Address - Country:US
Mailing Address - Phone:623-308-2472
Mailing Address - Fax:
Practice Address - Street 1:6350 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2857
Practice Address - Country:US
Practice Address - Phone:623-308-2472
Practice Address - Fax:623-218-9061
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47222084P0800X
IDO-07842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ267520Medicaid
AZZ145746Medicare PIN