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Provider Provider Pc
General Practice Physician in Mesa, Arizona
NPI 1760969190

Provider Provider Pc is a General Practice Physician based in Mesa, AZ. Provider Provider Pc practices in Mesa, AZ. The NPI Number for Provider Provider Pc is 1760969190 and holds a License No. (Arizona).

The current practice location address for Provider Provider Pc is 841 W 11Th St, Mesa, AZ and can be reached out via phone at 480-461-9822.

Location: 841 W 11Th St, Mesa, AZ, 85201-3109
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1760969190
Provider Name
Provider Provider Pc
Credential
Provider Entity Type
Organization
Address
841 W 11Th St, Mesa, AZ, 85201-3109
Phone Number
480-461-9822
Fax Number
Provider Enumeration Date
07/28/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
841 W 11Th St
City
Mesa
State
Arizona
Zip
85201-3109
Phone Number
480-461-9822
Fax Number
person
Provider Business Mailing Address Details
Address
841 W 11Th St
City
Mesa
State
Arizona
Zip
85201-3109
Phone Number
480-461-9822
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
()
Definition
Definition to come...
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