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General NPI Number Information
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NPI Number | 1982668935
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Entity Type | Organization
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Legal Business Name | OCOTILLO FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 16515 S 40TH ST SUITE 109
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City | PHOENIX
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State | AZ
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Zip | 85048-0558
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Country | US
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Telephone | 480-706-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 16515 S 40TH ST SUITE 109
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City | PHOENIX
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State | AZ
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Zip | 85048-0558
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Country | US
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Telephone | 480-706-0174
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GIL HOLLAND
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Credential | MD
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Telephone | 480-706-0174
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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 | 31233
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License Number State | AZ
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