Provider Demographics
NPI:1679085294
Name:DESPRES, PAUL (NMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DESPRES
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 E BLUEJAY LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7380
Mailing Address - Country:US
Mailing Address - Phone:602-684-6511
Mailing Address - Fax:
Practice Address - Street 1:323 N LEROUX ST STE B
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4555
Practice Address - Country:US
Practice Address - Phone:928-213-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1694175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath