Basic Information
| Provider Information | |||||||||
| NPI: | 1801041264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHOICE MEDICAL WALK IN PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39612 N BELFAIR WAY | ||||||||
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| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850863663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235515635 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12262 E BRADSHAW MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | DEWEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863276032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287721673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2008 | ||||||||
| LastUpdateDate: | 11/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | BRYAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6233269588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 3834 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.