# BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BANNER MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1326710906
- **Legal business name:** BANNER MEDICAL GROUP
- **Authorized official:** DENNIS LARAWAY (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (602) 747-4000

## Contact information

- **Practice address:** 9165 W THUNDERBIRD RD, PEORIA, AZ 85381-4847
- **Practice address phone:** (623) 285-1120
- **Practice address fax:** (623) 285-2626
- **Mailing address:** 2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133NN1002X | Nutrition Education Nutritionist | — | NULL | Yes |
| 133NN1002X | Nutrition Education Nutritionist | — | — | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/01/2021
- **Last updated:** 12/29/2021