NPIMap

Organization Active NPI

Dean D Ettinger MD PC

  • Pediatric Adolescent Medicine Physician
  • Sierra Vista, AZ
National Provider Identifier
1689925711
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
12142 Issued in AZ
Legal business name
DEAN D ETTINGER MD PC
Practice address
155 Calle Portal
Suite 200
Sierra Vista, AZ 85635-2900
Phone
(520) 458-0660
Fax
(520) 458-9550
NPI assigned
Sep 28, 2012
Last updated
Sep 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dean D Ettinger, M.D.NPI 1548257009
Title
Owner
Phone
(520) 458-0660

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 12142 AZ Primary

Addresses

Primary practice location

155 Calle Portal
Suite 200
Sierra Vista, AZ 85635-2900

Mailing address

155 Calle Portal
Suite 200
Sierra Vista, AZ 85635-2900
Phone (520) 458-0660

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1689925711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CALLE PORTAL",
            "address_2": "SUITE 200",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352900",
            "telephone_number": "520-458-0660",
            "fax_number": "520-458-9550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 CALLE PORTAL",
            "address_2": "SUITE 200",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352900",
            "telephone_number": "520-458-0660",
            "fax_number": "520-458-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN D ETTINGER MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-28",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "ETTINGER",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-458-0660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "AZ",
            "license": "12142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.