Individual
MARK DANIEL CAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5140 E THOMAS RD, PHOENIX, AZ 85018-7915
(602) 207-8400
(602) 535-3166
Mailing address
1847 W HEATHERBRAE DR, PHOENIX, AZ 85015-4764
(602) 274-2100
(602) 535-3166
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
8078
AZ
363AM0700X
Medical Physician Assistant
Primary
8078
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8078
PHYSICIAN ASSISTANT BOARD
AZ
Enumeration date
04/10/2020
Last updated
09/28/2020
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