Provider Demographics
NPI:1932390796
Name:DEIBLER PSYCHIATRIC, PLLC
Entity Type:Organization
Organization Name:DEIBLER PSYCHIATRIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEIBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-791-1282
Mailing Address - Street 1:3132 W STEINBECK DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1535
Mailing Address - Country:US
Mailing Address - Phone:602-791-1282
Mailing Address - Fax:
Practice Address - Street 1:2120 W RESERVATION LOOP RD
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322
Practice Address - Country:US
Practice Address - Phone:928-567-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ32333OtherSTATE LICENSE
AZ967739Medicaid
AZ967739Medicaid
AZZ116743Medicare PIN