# SIERRA BLANCA CLINIC, LTD.

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

## Provider details

- **NPI number:** 1801084827
- **Authorized official:** DR. MARK MITCHELL GARSKOF MD (PRESIDENT)
- **Authorized official phone:** (928) 368-0765

## Contact information

- **Practice address:** 2963 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-6257
- **Practice address phone:** (928) 368-0765
- **Mailing address:** PO BOX 1210, LAKESIDE, AZ 85929-1210
- **Mailing address phone:** (928) 368-0765

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 10885 | AZ | Yes |

## Other

- **Enumeration date:** 10/04/2007
- **Last updated:** 12/27/2016