=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740399633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUMA PRIMARY CARE P L L C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1881 W 24TH ST SUITE A
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-6297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-726-7171
-----------------------------------------------------
Fax | 928-726-7206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5089
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85366-5089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 928-726-7206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MORGAN BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-726-7171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 33831
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------