Healthcare Provider Details

I. General information

NPI: 1356857262
Provider Name (Legal Business Name): PGF MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 E ORANGE BLOSSOM LN STE 5
PHOENIX AZ
85018-8139
US

IV. Provider business mailing address

5656 E ORANGE BLOSSOM LN STE 5
PHOENIX AZ
85018-8139
US

V. Phone/Fax

Practice location:
  • Phone: 602-601-7429
  • Fax: 602-601-7428
Mailing address:
  • Phone: 602-601-7429
  • Fax: 602-601-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL G. FLATLEY
Title or Position: OWNER
Credential: DO
Phone: 602-601-7430