Provider Demographics
NPI:1154708451
Name:OPIE, DOUGLAS DANIEL (DO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DANIEL
Last Name:OPIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 E BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4450
Mailing Address - Country:US
Mailing Address - Phone:480-296-9232
Mailing Address - Fax:
Practice Address - Street 1:75 COLONIA DE SALUD STE 100C
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2485
Practice Address - Country:US
Practice Address - Phone:520-263-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ008630208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program