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Organization
CANYON MEDICAL CLINIC LLC
Active
Organization
CANYON MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA ERIC MOTL PA-C, MPAS (PHYSICIAN ASSISTANT)
(218) 371-9340
Entity
Organization
Contact information
Practice address
34501 S OLD BLACK CANYON HWY # 1, BLACK CANYON CITY, AZ 85324
(623) 374-5070
(623) 374-5068
Mailing address
14534 W HIDDEN TERRACE LOOP, LITCHFIELD PARK, AZ 85340-0989
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
—
1588081087
—
AZ
05
—
912701
—
AZ
Enumeration date
06/11/2018
Last updated
08/14/2018
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