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General NPI Number Information
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NPI Number | 1235410077
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Entity Type | Organization
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Legal Business Name | COLORADO RIVER PEDIATRICS, LLC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 1611 JOY LANE
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City | FORT MOHAVE
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State | AZ
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Zip | 86426
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Country | US
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Telephone | 928-788-8000
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Fax | 928-788-8008
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Provider Business Mailing Address
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Address Line | PO BOX 11009
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City | FORT MOHAVE
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State | AZ
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Zip | 86427
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Country | US
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Telephone | 928-788-8000
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Fax | 928-788-8008
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ALAN BARTON
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Credential | MD
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Telephone | 928-788-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 29312
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License Number State | AZ
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