| NPI | 1750937868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINNE BAILEY Credentialing Specialist 928-634-2236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2020-03-09 |