# OPAS & PUANGTONG JUTABHA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VALLEY MEDICAL CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508048273
- **Authorized official:** DR. PUANGTONG JUTABHA M.D. (OWNER)
- **Authorized official phone:** (928) 927-5454

## Contact information

- **Practice address:** 394 N CENTRAL BLVD, QUARTZSITE, AZ 85346-1499
- **Practice address phone:** (928) 927-5454
- **Practice address fax:** (927) 928-3303
- **Mailing address:** PO BOX 1499, QUARTZSITE, AZ 85346-1499
- **Mailing address phone:** (928) 927-5454
- **Mailing address fax:** (928) 927-3303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 11855 | AZ | Yes |
| 207R00000X | Internal Medicine Physician | 11915 | AZ | — |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 04/20/2008