=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811751894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUEBLO FAMILY PHYSICIANS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2024
-----------------------------------------------------
Last Update Date | 02/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15425 N GREENWAY HAYDEN LOOP STE A300
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-607-1124
-----------------------------------------------------
Fax | 480-607-1087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15425 N GREENWAY HAYDEN LOOP STE A300
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-607-1124
-----------------------------------------------------
Fax | 480-607-1087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER, DO
-----------------------------------------------------
Name | DONALD G CUNNINGHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-607-1124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------