Individual
DR. MICHAEL J DEMANGONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
463 S LAKE POWELL BLVD, PAGE, AZ 86040-0790
(928) 645-0945
(928) 645-3254
Mailing address
P.O. BOX 790, PAGE, AZ 86040-0790
(928) 645-1607
(928) 645-3254
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21633
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141573
—
AZ
Enumeration date
06/13/2005
Last updated
05/27/2011
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