Basic Information
| Provider Information | |||||||||
| NPI: | 1851957195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN GROUP OF ARIZONA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24573 | ||||||||
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| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556600300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1620 S STAPLEY DR STE 132 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852046655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808348804 | ||||||||
| FaxNumber: | 4804648287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2019 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | DINSDALE | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR, OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6027977070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.