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Organization
BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS FAMILY MEDICINE
Active
Organization
BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS FAMILY MEDICINE
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS E DAHLEN (SR VICE PRESIDENT - FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1300 N 12TH ST, STE 605, PHOENIX, AZ 85006-2848
(602) 239-4567
(602) 239-2067
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767618
—
AZ
Enumeration date
05/23/2006
Last updated
02/26/2015
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