Provider Demographics
NPI:1598940751
Name:AHWATUKEE FAMILY PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:AHWATUKEE FAMILY PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-893-2900
Mailing Address - Street 1:4950 E ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4306
Mailing Address - Country:US
Mailing Address - Phone:480-893-2900
Mailing Address - Fax:480-893-2911
Practice Address - Street 1:4950 E ELLIOT RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4306
Practice Address - Country:US
Practice Address - Phone:480-893-2900
Practice Address - Fax:480-893-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z08ZWCHZN02Medicare PIN
AZZWCHZN01Medicare PIN