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Organization
PHOENIX EMERGENCY PHYSICIANS
Active
Organization
PHOENIX EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAIL ANN HUBBELL MD (MEDICAL DIRECTOR)
(209) 342-2300
Entity
Organization
Contact information
Practice address
13855 E 14TH ST, SAN LEANDRO, CA 94578-2611
(209) 342-2300
(209) 524-4240
Mailing address
4301 NORTHSTAR WAY, MODESTO, CA 95356-9262
(209) 342-2300
(209) 524-4240
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
27483
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0053820
—
CA
01
—
ZZZ34666Z
BLUE SHIELD
CA
Enumeration date
11/02/2005
Last updated
08/26/2008
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