MEDICARE: SONORAN SPORTS & FAMILY MEDICINE PLC

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	30501	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942488861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN SPORTS & FAMILY MEDICINE PLC

Provider Business Mailing Address
First Line	:	3930 S ALMA SCHOOL RD
Second Line	:	SUITE 8
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-802-1300
Fax Number	:	480-802-1359

Provider Business Practice Location Address
First Line	:	3930 S ALMA SCHOOL RD
Second Line	:	SUITE 8
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-802-1300
Fax Number	:	480-802-1359

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY TODD DAVIS
Credential	:	MD
Telephone Number	:	480-802-1300

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	05/19/2008

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