Healthcare Provider Details

I. General information

NPI: 1801539317
Provider Name (Legal Business Name): FLYING PIG OFFROAD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O DEBORA MCCLARY, M.D. 7776 W QUAIL AVE
PEORIA AZ
85382-3322
US

IV. Provider business mailing address

PO BOX 10356
GLENDALE AZ
85318-0356
US

V. Phone/Fax

Practice location:
  • Phone: 480-707-9504
  • Fax: 602-581-7764
Mailing address:
  • Phone: 480-707-9504
  • Fax: 602-581-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBORA MCCLARY
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 480-707-9504