Healthcare Provider Details

I. General information

NPI: 1427894005
Provider Name (Legal Business Name): PAUL MCALLISTER BADGER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5882 S HOSPITAL DR STE 1
GLOBE AZ
85501-9455
US

IV. Provider business mailing address

1208 S 7TH AVE
SAFFORD AZ
85546-2917
US

V. Phone/Fax

Practice location:
  • Phone: 928-793-3747
  • Fax:
Mailing address:
  • Phone: 928-965-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number310169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: