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General NPI Number Information
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NPI Number | 1366647158
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Entity Type | Organization
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Legal Business Name | DESERT HILLS FAMILY MEDICINE PC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 20325 N. 51ST AVENUE BLDG 9, #170
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City | GLENDALE
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State | AZ
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Zip | 85308-5674
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Country | US
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Telephone | 602-296-4231
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Fax |
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Provider Business Mailing Address
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Address Line | 20325 N. 51ST AVENUE BLDG 9, #170
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City | GLENDALE
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State | AZ
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Zip | 85308-5674
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Country | US
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Telephone | 602-296-4231
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH F RAYNAK
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Credential | M.D.
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Telephone | 602-547-8184
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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 | 13497
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License Number State | AZ
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