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General NPI Number Information
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NPI Number | 1053584664
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Entity Type | Organization
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Legal Business Name | FAMILY CARE ASSOCIATES PC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 3048 E BASELINE RD STE 122
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City | MESA
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State | AZ
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Zip | 85204-7286
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Country | US
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Telephone | 480-827-9945
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Fax | 480-834-6244
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Provider Business Mailing Address
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Address Line | 3048 E BASELINE RD STE 122
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City | MESA
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State | AZ
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Zip | 85204-7286
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Country | US
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Telephone | 480-827-9945
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Fax | 480-834-6244
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | STUART H AGREN
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Credential | MD
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Telephone | 48808279945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AZ15251
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License Number State | AZ
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