Provider Demographics
NPI:1609028661
Name:CANYON PHYSICIANS II
Entity Type:Organization
Organization Name:CANYON PHYSICIANS II
Other - Org Name:CANYON PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-432-1114
Mailing Address - Street 1:1825 E NORTHERN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3940
Mailing Address - Country:US
Mailing Address - Phone:602-424-8425
Mailing Address - Fax:
Practice Address - Street 1:13206 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5394
Practice Address - Country:US
Practice Address - Phone:602-866-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty