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General NPI Number Information
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NPI Number | 1073771721
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Entity Type | Organization
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Legal Business Name | SUN MEADOW FAMILY MEDICINE INC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 1455 W CHANDLER BLVD SUITE B-11
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City | CHANDLER
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State | AZ
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Zip | 85224-6177
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Country | US
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Telephone | 480-917-9208
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Fax | 480-814-7443
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Provider Business Mailing Address
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Address Line | 1455 W CHANDLER BLVD SUITE B-11
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City | CHANDLER
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State | AZ
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Zip | 85224-6177
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Country | US
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Telephone | 480-917-9208
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Fax | 480-814-7443
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN BRIONES
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Credential | MD
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Telephone | 480-917-9208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22101
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License Number State | AZ
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