Provider Demographics
NPI:1619620200
Name:DESERET FAMILY MEDICINE AT GREENFIELD PLC
Entity Type:Organization
Organization Name:DESERET FAMILY MEDICINE AT GREENFIELD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-981-3000
Mailing Address - Street 1:7165 E UNIVERSITY DR STE 141
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-6411
Mailing Address - Country:US
Mailing Address - Phone:480-981-3000
Mailing Address - Fax:480-924-6339
Practice Address - Street 1:7165 E UNIVERSITY DR STE 141
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6411
Practice Address - Country:US
Practice Address - Phone:480-981-3000
Practice Address - Fax:480-924-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care