Provider Demographics
NPI:1033507033
Name:ARIZONA DOCTORS, LLC
Entity Type:Organization
Organization Name:ARIZONA DOCTORS, LLC
Other - Org Name:MD24 ARIZONA, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF CLINICIAN OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEQIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-626-4473
Mailing Address - Street 1:6739 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5311
Mailing Address - Country:US
Mailing Address - Phone:623-240-1110
Mailing Address - Fax:623-889-0814
Practice Address - Street 1:6739 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5311
Practice Address - Country:US
Practice Address - Phone:623-240-1110
Practice Address - Fax:623-889-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ003323Medicaid
AZZ175634Medicare PIN