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General NPI Number Information
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NPI Number | 1861624793
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Entity Type | Organization
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Legal Business Name | SAN TAN MOUNTAIN PEDIATRICS PLC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 3303 S LINDSAY RD STE 110
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City | GILBERT
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State | AZ
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Zip | 85297-1504
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Country | US
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Telephone | 480-659-5811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6443
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City | CHANDLER
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State | AZ
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Zip | 85246-6443
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Country | US
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Telephone | 480-659-5811
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CINDY DUKE
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Credential | MD
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Telephone | 480-659-5811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 29688
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License Number State | AZ
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