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General NPI Number Information
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NPI Number | 1851996102
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Entity Type | Organization
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Legal Business Name | FRIENDLY MEDICAL GROUP
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 727 E BETHANY HOME RD STE A101
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City | PHOENIX
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State | AZ
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Zip | 85014-2192
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Country | US
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Telephone | 706-961-4298
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Fax |
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Provider Business Mailing Address
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Address Line | 3424 W LONG RIFLE RD
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City | PHOENIX
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State | AZ
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Zip | 85086-4301
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Country | US
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Telephone | 706-961-4298
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TAN VU
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Credential | MD
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Telephone | 706-961-4298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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