# GILA VALLEY MEDICAL GROUP LLC

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

## Provider details

- **NPI number:** 1992929004
- **Authorized official:** RONALD D BROOKSHER MD (OWNER)
- **Authorized official phone:** (928) 344-6263

## Contact information

- **Practice address:** 1951 WEST 25TH STREET, SUITE D, YUMA, AZ 85364
- **Practice address phone:** (928) 344-6263
- **Practice address fax:** (928) 785-9572
- **Mailing address:** 1951 WEST 25TH STREET, SUITE D, YUMA, AZ 85364
- **Mailing address phone:** (928) 344-6263

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 20396 | AZ | Yes |
| 363A00000X | Physician Assistant | 2125 | AZ | — |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 05/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 076275001 | AACCS | — |