Provider Demographics
NPI:1952348955
Name:DONALD E PAXTON MD LLC
Entity Type:Organization
Organization Name:DONALD E PAXTON MD LLC
Other - Org Name:DONALD E PAXTON MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-241-9500
Mailing Address - Street 1:202 E EARLL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2675
Mailing Address - Country:US
Mailing Address - Phone:602-241-9500
Mailing Address - Fax:602-241-9552
Practice Address - Street 1:202 E EARLL DR
Practice Address - Street 2:STE 450
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2634
Practice Address - Country:US
Practice Address - Phone:602-241-9500
Practice Address - Fax:602-241-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPFP13PAXTD01Medicaid
D37431Medicare UPIN
AZZ108748Medicare ID - Type Unspecified