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Organization
BLACK CANYON MEDICAL
Active
Organization
BLACK CANYON MEDICAL
Active
Other names
BRADSHAW MOUNTAIN FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY CHARLES HANCOCK D.O. (OWNER)
(623) 742-6428
Entity
Organization
Contact information
Practice address
17301 E SPRING VALLEY RD, STE F, SPRING VALLEY, AZ 86333-4263
(928) 632-4909
(623) 374-5576
Mailing address
46641 N BLACK CANYON HWY, STE 5, NEW RIVER, AZ 85087-6941
(623) 742-6428
(623) 465-1561
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
3297
AZ
Other
Enumeration date
09/24/2007
Last updated
09/24/2007
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