Provider Demographics
NPI:1720070303
Name:PRESCOTT FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:PRESCOTT FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-4100
Mailing Address - Street 1:726 GAIL GARDNER WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2314
Mailing Address - Country:US
Mailing Address - Phone:928-445-4100
Mailing Address - Fax:928-445-9132
Practice Address - Street 1:726 GAIL GARDNER WAY
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2314
Practice Address - Country:US
Practice Address - Phone:928-445-4100
Practice Address - Fax:928-445-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
107085OtherAETNA