Healthcare Provider Details

I. General information

NPI: 1053498063
Provider Name (Legal Business Name): PARADISE VALLEY FAMILY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD STE 107
PHOENIX AZ
85032-2138
US

IV. Provider business mailing address

3811 E BELL RD STE 107
PHOENIX AZ
85032-2138
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-6100
  • Fax: 602-992-6424
Mailing address:
  • Phone: 602-482-6100
  • Fax: 602-992-6424

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 Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN D MARSHALL
Title or Position: MANAGING MANAGER
Credential: MD
Phone: 602-482-6100