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General NPI Number Information
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NPI Number | 1063443273
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Entity Type | Individual
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Provider Name | GREGG PHILLIPS STANDAGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1515 S 20TH AVE
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City | SAFFORD
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State | AZ
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Zip | 85546-4009
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Country | US
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Telephone | 928-348-1370
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Fax | 928-348-1375
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Provider Business Mailing Address
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Address Line | 225 S REAY LN
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City | THATCHER
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State | AZ
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Zip | 85552-5417
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Country | US
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Telephone | 928-428-0144
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Fax | 928-348-1375
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD22289
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License Number State | AZ
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