Provider Demographics
NPI:1013048149
Name:DEAN ETTINGER MD, PC
Entity type:Organization
Organization Name:DEAN ETTINGER MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-458-0660
Mailing Address - Street 1:155 CALLE PORTAL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-458-0660
Mailing Address - Fax:520-458-9550
Practice Address - Street 1:155 CALLE PORTAL
Practice Address - Street 2:SUITE 200
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-458-0660
Practice Address - Fax:520-458-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty