Provider Demographics
NPI:1770678120
Name:PRICE, DEANNA KAYE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:KAYE
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:KAYE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5987
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:1050 GAIL GARDNER WAY STE 100
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1631
Practice Address - Country:US
Practice Address - Phone:928-777-0700
Practice Address - Fax:928-445-4464
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63779207R00000X
AZ50912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA63779OtherHMO
AZ50912OtherARIZONA MEDICAL BOARD
CA00A637790OtherBLUESHIELD
CAA63779OtherPPO/COMM
CAA63779OtherBLUECROSS
AZ044021Medicaid
CA952585978OtherCHAMPUS
CA952585978OtherCHAMPUS