Provider Demographics
NPI:1114030491
Name:SELTZER, DANA G (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:G
Last Name:SELTZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7797 W PARADISE LN STE 130
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5011
Mailing Address - Country:US
Mailing Address - Phone:623-547-7502
Mailing Address - Fax:623-414-3503
Practice Address - Street 1:7797 W PARADISE LN STE 130
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5011
Practice Address - Country:US
Practice Address - Phone:623-547-7502
Practice Address - Fax:623-414-3503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21798207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ149999Medicaid
AZ101784Medicare ID - Type UnspecifiedMEDICARE #
AZ149999Medicaid