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General NPI Number Information
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NPI Number | 1720159841
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Entity Type | Organization
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Legal Business Name | ARIZONA VISTA FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 875 N GREENFIELD RD # 101
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City | GILBERT
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State | AZ
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Zip | 85234-5044
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Country | US
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Telephone | 480-892-1212
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Fax | 480-892-4941
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Provider Business Mailing Address
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Address Line | 875 N GREENFIELD RD # 101
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City | GILBERT
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State | AZ
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Zip | 85234-5044
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Country | US
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Telephone | 480-892-1212
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Fax | 480-892-4941
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Authorized Official
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Title or Position | PRESIDENT OF AVFM
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Name | DR. TERESA LANIER
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Credential | MD., PHD.
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Telephone | 480-892-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3160
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26887
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License Number State | AZ
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