Provider Demographics
NPI:1720265333
Name:TURF PARADISE MEDICAL PLLC
Entity Type:Organization
Organization Name:TURF PARADISE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:BROKAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-518-3373
Mailing Address - Street 1:9909 E PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5920
Mailing Address - Country:US
Mailing Address - Phone:480-518-3373
Mailing Address - Fax:602-843-8130
Practice Address - Street 1:1501 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3411
Practice Address - Country:US
Practice Address - Phone:480-518-3373
Practice Address - Fax:602-843-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16107261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care