Provider Demographics
NPI:1356794150
Name:SCHANER, DAVID RYAN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RYAN
Last Name:SCHANER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12533 W COLDWATER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8320
Mailing Address - Country:US
Mailing Address - Phone:623-466-7673
Mailing Address - Fax:623-399-6041
Practice Address - Street 1:12533 W COLDWATER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-8320
Practice Address - Country:US
Practice Address - Phone:623-466-7673
Practice Address - Fax:623-399-6041
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10009H302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization