Provider Demographics
NPI:1710025051
Name:PAPAGO MEDICAL, PC
Entity Type:Organization
Organization Name:PAPAGO MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-459-0144
Mailing Address - Street 1:1729 PASEO SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4611
Mailing Address - Country:US
Mailing Address - Phone:520-459-0144
Mailing Address - Fax:520-459-8541
Practice Address - Street 1:1729 PASEO SAN LUIS
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4611
Practice Address - Country:US
Practice Address - Phone:520-459-0144
Practice Address - Fax:520-459-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119562Medicaid
AZ119562Medicaid
AZZMD21105Medicare ID - Type Unspecified