# ARIZONA FAMILY MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548426489
- **Authorized official:** DR. R DOUGLAS HADE MD (OWNER)
- **Authorized official phone:** (928) 680-4233

## Contact information

- **Practice address:** 2082 MESQUITE AVE, SUITE A106, LAKE HAVASU CITY, AZ 86403-6710
- **Practice address phone:** (928) 680-4233
- **Practice address fax:** (928) 680-6522
- **Mailing address:** PO BOX 3510, LAKE HAVASU CITY, AZ 86405-3510
- **Mailing address phone:** (928) 680-4233
- **Mailing address fax:** (928) 680-6522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 18114 | AZ | Yes |

## Other

- **Enumeration date:** 07/30/2008
- **Last updated:** 08/29/2008

## 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 |