Provider Demographics
NPI:1639539232
Name:PEORIA OB GYN, LLC
Entity Type:Organization
Organization Name:PEORIA OB GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:NARINDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-547-7205
Mailing Address - Street 1:14961 W BELL RD STE 175
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3220
Mailing Address - Country:US
Mailing Address - Phone:623-547-7205
Mailing Address - Fax:
Practice Address - Street 1:14961 W BELL RD STE 175
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3220
Practice Address - Country:US
Practice Address - Phone:623-547-7205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty