Healthcare Provider Details

I. General information

NPI: 1972323657
Provider Name (Legal Business Name): ESPOIR MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 W UNION HILLS DRIVE SUITE 107
PEORIA AZ
85382
US

IV. Provider business mailing address

9015 W UNION HILLS DR STE 107
PEORIA AZ
85382-3106
US

V. Phone/Fax

Practice location:
  • Phone: 623-329-7389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LYNN A BROWN
Title or Position: CHIEF OPERATING OFFICER
Credential: JD
Phone: 623-329-7389