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General NPI Number Information
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NPI Number | 1467580894
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Entity Type | Organization
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Legal Business Name | WHITE MOUNTAIN FAMILY PRACTICE ASSOCIATES LTD
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 5658 HIGHWAY 260 SUITE 19
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City | LAKESIDE
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State | AZ
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Zip | 85929-5189
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Country | US
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Telephone | 928-532-5838
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Fax | 928-532-6670
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Provider Business Mailing Address
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Address Line | 5658 HIGHWAY 260 SUITE 19
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City | LAKESIDE
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State | AZ
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Zip | 85929-5189
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Country | US
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Telephone | 928-532-5838
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Fax | 928-532-6670
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Authorized Official
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Title or Position | MANAGER
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Name | LINDA NEEL
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Credential |
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Telephone | 928-532-5838
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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 | 7081
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License Number State | AZ
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