David Thurlow Ackley, M.D.
Individual provider Active NPI Family Medicine Physician · Polacca, AZ
NPI 1801947767 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1801947767
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Practice address
- Highway 264 Milepost 388
Polacca, AZ 86042 - Phone
- (928) 737-6321
- Fax
- (928) 737-6001
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-107293 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS IHS Phoenix Area | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | IL | Yes |
Addresses
Primary practice location
Highway 264 Milepost 388
Polacca, AZ 86042
Mailing address
PO Box 966
Hwy 264 Milepost 388
Polacca, AZ 86042-0966
Phone (928) 737-1095
Other providers in Polacca, AZ
All providers in Polacca, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.