Provider Demographics
NPI:1811751894
Name:PUEBLO FAMILY PHYSICIANS LTD
Entity type:Organization
Organization Name:PUEBLO FAMILY PHYSICIANS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, DO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-607-1124
Mailing Address - Street 1:15425 N GREENWAY HAYDEN LOOP STE A300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1204
Mailing Address - Country:US
Mailing Address - Phone:480-607-1124
Mailing Address - Fax:480-607-1087
Practice Address - Street 1:15425 N GREENWAY HAYDEN LOOP STE A300
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1204
Practice Address - Country:US
Practice Address - Phone:480-607-1124
Practice Address - Fax:480-607-1087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUEBLO FAMILY PHYSICIANS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty