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Organization
CAVE CREEK CLINIC, LLC
Active
Organization
CAVE CREEK CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN SHERMAN GILLIAM MD (MEDICAL DIRECTOR)
(480) 401-1555
Entity
Organization
Contact information
Practice address
2920 E MOHAWK LN STE 101, PHOENIX, AZ 85050-4773
(480) 401-1555
(800) 930-4408
Mailing address
15029 N THOMPSON PEAK PKWY # B111-438, SCOTTSDALE, AZ 85260-2217
(480) 401-1555
(800) 930-4408
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
388615
—
AZ
05
—
600874
—
AZ
Enumeration date
02/02/2019
Last updated
06/11/2019
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