Basic Information
| Provider Information | |||||||||
| NPI: | 1578590303 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SQUAW PEAK FAMILY PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9327 N 3RD STREET | ||||||||
| Address2: | #100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023713100 | ||||||||
| FaxNumber: | 6023710050 | ||||||||
| Practice Location | |||||||||
| Address1: | 9327 N 3RD STREET | ||||||||
| Address2: | #100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023713100 | ||||||||
| FaxNumber: | 6023710050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KELLEY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6023713100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.