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General NPI Number Information
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NPI Number | 1548389265
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Entity Type | Organization
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Legal Business Name | PIERPONT MEDICAL GROUP, LTD
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4852 E BASELINE RD SUITE #103
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City | MESA
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State | AZ
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Zip | 85206-4627
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Country | US
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Telephone | 480-830-1040
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Fax | 480-981-3130
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Provider Business Mailing Address
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Address Line | 9221 E BASELINE RD SUITE A109, #289
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City | MESA
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State | AZ
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Zip | 85209-8310
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Country | US
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Telephone | 480-830-1040
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Fax | 480-981-3130
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. ROBIN LYNN NICE
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Credential |
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Telephone | 480-830-1040
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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 | 14449
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License Number State | AZ
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