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General NPI Number Information
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NPI Number | 1720265333
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Entity Type | Organization
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Legal Business Name | TURF PARADISE MEDICAL PLLC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 1501 W BELL RD
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City | PHOENIX
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State | AZ
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Zip | 85023-3411
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Country | US
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Telephone | 480-518-3373
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Fax | 602-843-8130
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Provider Business Mailing Address
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Address Line | 9909 E PARADISE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5920
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Country | US
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Telephone | 480-518-3373
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Fax | 602-843-8130
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAWN DIANNE BROKAW
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Credential | M.D.
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Telephone | 480-518-3373
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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 | 16107
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License Number State | AZ
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