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General NPI Number Information
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NPI Number | 1770556284
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Entity Type | Organization
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Legal Business Name | 51 MDOS
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 51 MDOS PSC 3 BOX 2652
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City | APO
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State | AP
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Zip | 96266
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Country | KR
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Telephone | 315-874-7473
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Fax |
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Provider Business Mailing Address
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Address Line | 2353 N 123RD DR
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City | AVONDALE
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State | AZ
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Zip | 85323-6500
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Country | US
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Telephone | 623-535-8432
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | JAMES LAMUNYON
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Credential | PA-CERTIFIED
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Telephone | 315-784-7473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | AZ
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