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General NPI Number Information
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NPI Number | 1649417817
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Entity Type | Organization
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Legal Business Name | T-BIRD FAMILY & INDUSTRIAL PHYSICIANS, P.C.
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 14045 N 7TH ST SUITE #1
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City | PHOENIX
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State | AZ
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Zip | 85022-4388
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Country | US
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Telephone | 602-866-0961
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Fax | 602-866-9820
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Provider Business Mailing Address
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Address Line | 14045 N. 7TH ST. SUITE #1
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City | PHOENIX
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State | AZ
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Zip | 85022-4387
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Country | US
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Telephone | 602-866-0961
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Fax | 602-866-9820
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PEGI ENGLE
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Credential |
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Telephone | 602-866-0961
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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 | 2019
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License Number State | AZ
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