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General NPI Number Information
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NPI Number | 1629252945
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Entity Type | Organization
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Legal Business Name | REPLOGLE MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 11871 S FORTUNA RD
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City | YUMA
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State | AZ
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Zip | 85367-7686
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Country | US
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Telephone | 928-342-9020
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Fax | 928-342-2158
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Provider Business Mailing Address
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Address Line | 11871 S FORTUNA RD
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City | YUMA
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State | AZ
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Zip | 85367-7686
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Country | US
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Telephone | 928-342-9020
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Fax | 928-342-2158
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STEPHEN P REPLOGLE
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Credential | D.O.
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Telephone | 928-342-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2757
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License Number State | AZ
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