Provider Demographics
NPI:1801947767
Name:ACKLEY, DAVID THURLOW (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THURLOW
Last Name:ACKLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:HWY 264 MILEPOST 388
Mailing Address - City:POLACCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86042-0966
Mailing Address - Country:US
Mailing Address - Phone:928-737-1095
Mailing Address - Fax:928-737-6100
Practice Address - Street 1:HIGHWAY 264 MILEPOST 388
Practice Address - Street 2:
Practice Address - City:POLACCA
Practice Address - State:AZ
Practice Address - Zip Code:86042
Practice Address - Country:US
Practice Address - Phone:928-737-6321
Practice Address - Fax:928-737-6001
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH75699Medicare UPIN