MEDICARE: FIRST FAMILY MEDICAL GROUP

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1215131107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST FAMILY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1444 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1624
Country	:	US
Telephone Number	:	800-353-5420
Fax Number	:	866-897-5366

Provider Business Practice Location Address
First Line	:	1444 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1624
Country	:	US
Telephone Number	:	800-353-5420
Fax Number	:	866-897-5366

Authorized Official
Title or Position	:	PROVIDER
Name	:	DR. KENNETH FISHER
Credential	:
Telephone Number	:	800-353-5420

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/22/2020

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