Healthcare Provider Details

I. General information

NPI: 1285703918
Provider Name (Legal Business Name): FLAGSTAFF PRIMARY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S YALE ST STE #252
FLAGSTAFF AZ
86001-7304
US

IV. Provider business mailing address

1501 S YALE ST STE #252
FLAGSTAFF AZ
86001-7304
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-1811
  • Fax: 928-774-2006
Mailing address:
  • Phone: 928-774-1811
  • Fax: 928-774-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. LAUREN H. STUART
Title or Position: OWNER/TREASURER
Credential: M.D.
Phone: 928-774-1811