Provider Demographics
NPI:1780684324
Name:OPILA, DONALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:OPILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 E OSBORN DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6435
Mailing Address - Country:US
Mailing Address - Phone:480-994-1166
Mailing Address - Fax:480-425-0515
Practice Address - Street 1:7331 E OSBORN DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6435
Practice Address - Country:US
Practice Address - Phone:480-994-1166
Practice Address - Fax:480-425-0515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
AZAZ21856207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158057Medicaid
AZ61641Medicare PIN
AZB71038Medicare UPIN