MEDICARE: SONORAN FAMILY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1252	AZ

General Provider Information

NPI Number	:	1770748477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	171 W CENTRAL AVE
Second Line	:
City	:	COOLIDGE
State	:	AZ
Zip	:	85228-4405
Country	:	US
Telephone Number	:	520-723-7726
Fax Number	:	520-723-4513

Provider Business Practice Location Address
First Line	:	171 W CENTRAL AVE
Second Line	:
City	:	COOLIDGE
State	:	AZ
Zip	:	85228-4405
Country	:	US
Telephone Number	:	520-723-7726
Fax Number	:	520-723-4513

Authorized Official
Title or Position	:	PA-C
Name	:	EDWARD J. POWELL
Credential	:	PA-C
Telephone Number	:	520-723-7726

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	09/23/2008

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Directions to “SONORAN FAMILY PRACTICE ” Practice Location

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