Provider Demographics
NPI:1861624793
Name:SAN TAN MOUNTAIN PEDIATRICS PLC
Entity type:Organization
Organization Name:SAN TAN MOUNTAIN PEDIATRICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-659-5811
Mailing Address - Street 1:PO BOX 6443
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6443
Mailing Address - Country:US
Mailing Address - Phone:480-659-5811
Mailing Address - Fax:
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:STE 110
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1504
Practice Address - Country:US
Practice Address - Phone:480-659-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29688208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty