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Organization
BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Active
Organization
BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Active
Parent organization
BANNER MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP
Authorized official
DENNIS LARAWAY (CHIEF FINANCIAL OFFICER)
(602) 747-4000
Entity
Organization
Contact information
Practice address
9165 W THUNDERBIRD RD, PEORIA, AZ 85381-4847
(623) 285-1120
(623) 285-2626
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
NULL
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
Other
Enumeration date
10/01/2021
Last updated
12/29/2021
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