Provider Demographics
NPI:1992345664
Name:PHYSICIAN GROUP OF ARIZONA INC
Entity type:Organization
Organization Name:PHYSICIAN GROUP OF ARIZONA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-797-7070
Mailing Address - Street 1:1900 N PERAL STREET
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2470
Mailing Address - Country:US
Mailing Address - Phone:469-341-8800
Mailing Address - Fax:
Practice Address - Street 1:7727 W DEER VALLEY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2120
Practice Address - Country:US
Practice Address - Phone:602-553-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty