# MESA CLINIC OF PHYSICIANS AND SURGEONS, PLLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063603470
- **Authorized official:** MRS. SANDRA BAKE (ADMINISTRATOR)
- **Authorized official phone:** (480) 733-4401

## Contact information

- **Practice address:** 606 N COUNTRY CLUB DR, \#1, MESA, AZ 85201
- **Practice address phone:** (480) 969-3511
- **Practice address fax:** (480) 969-0976
- **Mailing address:** 606 N COUNTRY CLUB DR, \#1, MESA, AZ 85201
- **Mailing address phone:** (480) 733-4432
- **Mailing address fax:** (480) 733-4447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/09/2007
- **Last updated:** 01/24/2008