Provider Demographics
NPI:1477222669
Name:P&G FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:P&G FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:520-723-7726
Mailing Address - Street 1:171 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-4405
Mailing Address - Country:US
Mailing Address - Phone:520-723-7726
Mailing Address - Fax:520-723-4513
Practice Address - Street 1:1653 E MCMURRAY BLVD STE 144A
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5934
Practice Address - Country:US
Practice Address - Phone:480-883-3011
Practice Address - Fax:480-802-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty