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General NPI Number Information
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NPI Number | 1417112541
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Entity Type | Organization
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Legal Business Name | GOLD CANYON INTERNAL MEDICINE
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 6724 S KINGS RANCH RD STE 102
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City | GOLD CANYON
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State | AZ
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Zip | 85118-2963
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Country | US
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Telephone | 480-626-4999
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Fax | 480-304-3239
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Provider Business Mailing Address
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Address Line | 6724 S KINGS RANCH RD STE 102
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City | GOLD CANYON
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State | AZ
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Zip | 85118-2963
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Country | US
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Telephone | 480-626-4999
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Fax | 480-304-3239
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Authorized Official
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Title or Position | CEO
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Name | GEORGE K FAHNBULLEH
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Credential |
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Telephone | 480-525-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25933
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License Number State | AZ
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