Provider Demographics
NPI:1184694911
Name:SOLOMON, DAVID BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BARRY
Last Name:SOLOMON
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 1:10615 W THUNDERBIRD BLVD
Mailing Address - Street 2:SUITE 125, BLDG B
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3033
Mailing Address - Country:US
Mailing Address - Phone:623-974-3659
Mailing Address - Fax:623-974-0018
Practice Address - Street 1:10615 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 125, BLDG B
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3033
Practice Address - Country:US
Practice Address - Phone:623-974-3659
Practice Address - Fax:623-974-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2173735OtherAETNA PROVIDER
070013674OtherRAILROAD MEDICARE
AZAZ0853180OtherBC PROVIDER ID
AZAZ0853180OtherBC PROVIDER ID
070013674OtherRAILROAD MEDICARE