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NPI Code Detail

MEDICARE: SUN VALLEY GERIATRIC MEDICINE, P.C.

MEDICARE: SUN VALLEY GERIATRIC MEDICINE, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician46497AZ

General Provider Information

NPI Number : 1023434354
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUN VALLEY GERIATRIC MEDICINE, P.C.
Provider Business Mailing Address
First Line : 6740 W DEER VALLEY RD
Second Line : SUITE D 107
City : GLENDALE
State : AZ
Zip : 85310-5953
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6740 W DEER VALLEY RD
Second Line : SUITE D 107
City : GLENDALE
State : AZ
Zip : 85310-5953
Country : US
Telephone Number : 623-734-7414
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MATTHEW D SKINNER
Credential : M.D.
Telephone Number : 623-734-7414
Provider Enumeration Date : 03/11/2014
Last Update Date : 03/11/2014

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Directions to “SUN VALLEY GERIATRIC MEDICINE, P.C. ” Practice Location

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