Provider Demographics
NPI:1386624302
Name:HALLER, DEANNA (DO)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:HALLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3493 S MERCY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0434
Mailing Address - Country:US
Mailing Address - Phone:480-827-5042
Mailing Address - Fax:480-827-5096
Practice Address - Street 1:3493 S MERCY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0434
Practice Address - Country:US
Practice Address - Phone:520-694-5437
Practice Address - Fax:520-874-7070
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324632Medicaid
AZ68177Medicare ID - Type Unspecified
AZ324632Medicaid