Individual
CASEY DALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
750 E THUNDERBIRD RD STE 1-3, PHOENIX, AZ 85022-5306
(602) 230-7373
(602) 218-6383
Mailing address
3101 N CENTRAL AVE STE 500, PHOENIX, AZ 85012-2639
(602) 230-7373
(602) 230-5105
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5564
AZ
363AM0700X
Medical Physician Assistant
Primary
5564
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
858038
—
AZ
Enumeration date
10/22/2013
Last updated
08/16/2023
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