Provider Demographics
NPI:1821272683
Name:PHOENIX FAMILY PHYSICIANS, LTD.
Entity Type:Organization
Organization Name:PHOENIX FAMILY PHYSICIANS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-246-7251
Mailing Address - Street 1:1190 E MISSOURI AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2734
Mailing Address - Country:US
Mailing Address - Phone:602-246-7251
Mailing Address - Fax:602-264-2462
Practice Address - Street 1:1190 E MISSOURI AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2734
Practice Address - Country:US
Practice Address - Phone:602-246-7251
Practice Address - Fax:602-264-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD37205Medicare UPIN