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Organization
ARIZONA FAMILY MEDICINE PC
Active
Organization
ARIZONA FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. R DOUGLAS HADE MD (OWNER)
(928) 680-4233
Entity
Organization
Contact information
Practice address
2082 MESQUITE AVE, SUITE A106, LAKE HAVASU CITY, AZ 86403-6710
(928) 680-4233
(928) 680-6522
Mailing address
PO BOX 3510, LAKE HAVASU CITY, AZ 86405-3510
(928) 680-4233
(928) 680-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18114
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016122
—
AZ
01
—
080153530
RAILROAD MEDICARE
AZ
01
—
1Z9241
HEALTH NET
AZ
01
—
AZ0327480
BLUE CROSS BLUE SHIELD
AZ
01
—
Z24643
MEDICARE GROUP #
AZ
Enumeration date
07/30/2008
Last updated
08/29/2008
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