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General NPI Number Information
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NPI Number | 1619188778
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Entity Type | Organization
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Legal Business Name | GLOBE FAMILY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2005 HIGHWAY 60
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City | GLOBE
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State | AZ
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Zip | 85501-9601
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Country | US
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Telephone | 928-425-5651
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Fax | 928-425-9644
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Provider Business Mailing Address
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Address Line | HC 2 BOX 3
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City | GLOBE
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State | AZ
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Zip | 85501-9773
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Country | US
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Telephone | 928-425-5651
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Fax | 928-425-9644
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Authorized Official
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Title or Position | PHYSICIAN
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Name | HECTOR A SALAZAR
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Credential | MD
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Telephone | 928-425-5651
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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 | 22596
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License Number State | AZ
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