# DESERT SPURS PRIMARY CARE, PLLC

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

## Provider details

- **NPI number:** 1730634965
- **Authorized official:** ROBERT J BAZACO M.D. (OWNER)
- **Authorized official phone:** (210) 464-8311

## Contact information

- **Practice address:** 1355 RAMAR RD, STE. 10, BULLHEAD CITY, AZ 86442-7100
- **Practice address phone:** (928) 444-8405
- **Practice address fax:** (928) 299-5300
- **Mailing address:** 251 MOSER AVE, APT. 105, BULLHEAD CITY, AZ 86429-5240
- **Mailing address phone:** (210) 464-8311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 48283 | AZ | Yes |

## Other

- **Enumeration date:** 08/17/2016
- **Last updated:** 08/17/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | P20970983 | CORPORATION ID\# | AZ |