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General NPI Number Information
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NPI Number | 1568644979
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Entity Type | Organization
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Legal Business Name | YUMA MEDICAL CLINIC P. C
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2851 S AVENUE B STE 1201
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City | YUMA
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State | AZ
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Zip | 85364-7745
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Country | US
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Telephone | 928-329-7000
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Fax | 928-329-9303
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Provider Business Mailing Address
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Address Line | 2851 S AVENUE B STE 1201
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City | YUMA
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State | AZ
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Zip | 85364-7745
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Country | US
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Telephone | 928-329-7000
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Fax | 928-329-9303
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MAHESH R SUBBU
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Credential | M.D.
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Telephone | 928-329-7000
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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 | 33028
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License Number State | AZ
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