Healthcare Provider Details

I. General information

NPI: 1215988209
Provider Name (Legal Business Name): POWER AND BROWN FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 E BROWN RD
MESA AZ
85207-3705
US

IV. Provider business mailing address

6820 E BROWN RD
MESA AZ
85207-3705
US

V. Phone/Fax

Practice location:
  • Phone: 480-924-9797
  • Fax: 480-924-9805
Mailing address:
  • Phone: 480-924-9797
  • Fax: 480-924-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. EROL J LEBLANC
Title or Position: PRESIDENT
Credential: DO
Phone: 480-924-9797