Provider Demographics
NPI:1801539317
Name:FLYING PIG OFFROAD PLLC
Entity type:Organization
Organization Name:FLYING PIG OFFROAD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-707-9504
Mailing Address - Street 1:PO BOX 10356
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0356
Mailing Address - Country:US
Mailing Address - Phone:480-707-9504
Mailing Address - Fax:602-581-7764
Practice Address - Street 1:C/O DEBORA MCCLARY, M.D.
Practice Address - Street 2:7776 W QUAIL AVE
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3322
Practice Address - Country:US
Practice Address - Phone:480-707-9504
Practice Address - Fax:602-581-7764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLYING PIG OFFROAD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service