Provider Demographics
NPI:1134441785
Name:FLAGSTAFF OBGYN LLC
Entity type:Organization
Organization Name:FLAGSTAFF OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-779-1162
Mailing Address - Street 1:1100 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3260
Mailing Address - Country:US
Mailing Address - Phone:928-779-1162
Mailing Address - Fax:928-779-1163
Practice Address - Street 1:1100 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3260
Practice Address - Country:US
Practice Address - Phone:928-779-1162
Practice Address - Fax:928-779-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3807174400000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty