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General NPI Number Information
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NPI Number | 1548426489
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Entity Type | Organization
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Legal Business Name | ARIZONA FAMILY MEDICINE PC
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 2082 MESQUITE AVE SUITE A106
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6710
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Country | US
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Telephone | 928-680-4233
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Fax | 928-680-6522
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Provider Business Mailing Address
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Address Line | PO BOX 3510
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-3510
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Country | US
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Telephone | 928-680-4233
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Fax | 928-680-6522
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Authorized Official
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Title or Position | OWNER
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Name | DR. R DOUGLAS HADE
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Credential | MD
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Telephone | 928-680-4233
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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 | 18114
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License Number State | AZ
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