| Banner Physician Specialists Arizona Llc | |
|
9165 W Thunderbird Rd Peoria AZ 85381-4847 | |
| (623) 285-1120 | |
| (623) 285-2626 |
| Full Name | Banner Physician Specialists Arizona Llc |
|---|---|
| Speciality | Nutritionist - Nutrition, Education |
| Location | 9165 W Thunderbird Rd, Peoria, Arizona |
| Authorized Official Name and Position | Dennis Laraway (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Physician Specialists Arizona Llc 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner Physician Specialists Arizona Llc 9165 W Thunderbird Rd Peoria AZ 85381-4847 Ph: (623) 285-1120 |
| NPI Number | 1326710906 |
|---|---|
| Provider Enumeration Date | 10/01/2021 |
| Last Update Date | 12/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326710906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 133NN1002X | Nutritionist - Nutrition, Education | (* (Not Available)) | Primary |
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