Provider Demographics
NPI:1104082650
Name:AZ FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:AZ FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:SAYEGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-264-5359
Mailing Address - Street 1:2601 N 3RD ST STE 308
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1101
Mailing Address - Country:US
Mailing Address - Phone:602-264-5359
Mailing Address - Fax:
Practice Address - Street 1:2601 N 3RD ST STE 308
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1101
Practice Address - Country:US
Practice Address - Phone:602-264-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ125325OtherMEDICARE PTAN