Provider Demographics
NPI:1194907154
Name:PARAGON MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:PARAGON MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:STOYKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-632-1117
Mailing Address - Street 1:3048 E. BASELINE RD
Mailing Address - Street 2:# 109
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204
Mailing Address - Country:US
Mailing Address - Phone:480-632-1117
Mailing Address - Fax:480-632-1118
Practice Address - Street 1:3048 E. BASELINE RD
Practice Address - Street 2:# 109
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204
Practice Address - Country:US
Practice Address - Phone:480-632-1117
Practice Address - Fax:480-632-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-02
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ65456Medicare PIN