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General NPI Number Information
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NPI Number | 1073986923
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Entity Type | Organization
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Legal Business Name | PAINTED DESERT PRIMARY CARE & GYNECOLOGY PC
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Dates
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Enumeration Date | 11/01/2015
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Last Update Date | 11/01/2015
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Provider Practice Location Address
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Address Line | 2020 SILVER CREEK RD BLDG. B, STE. 101A
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8476
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Country | US
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Telephone | 928-704-4336
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Fax | 928-704-0410
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Provider Business Mailing Address
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Address Line | 2020 SILVER CREEK RD BLDG. B, STE. 101A
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8476
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Country | US
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Telephone | 928-704-4336
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Fax | 928-704-0410
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Authorized Official
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Title or Position | DIRECTOR
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Name | TERESA M BORCHERS
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Credential | D.O.
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Telephone | 928-704-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 3681
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 3681
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License Number State | AZ
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