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General NPI Number Information
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NPI Number | 1285948521
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Entity Type | Organization
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Legal Business Name | SOUTHERN AVENUE FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 2034 E SOUTHERN AVE SUITE O
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City | TEMPE
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State | AZ
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Zip | 85282-7522
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Country | US
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Telephone | 480-777-0077
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Fax | 480-731-4741
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Provider Business Mailing Address
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Address Line | 2034 E SOUTHERN AVE SUITE O
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City | TEMPE
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State | AZ
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Zip | 85282-7522
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Country | US
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Telephone | 480-777-0077
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Fax | 480-731-4741
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN C BURNS
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Credential | M D
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Telephone | 480-777-0077
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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 | 15957
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License Number State | AZ
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