Organization
ARIZONA FAMILY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY LEE ELLISON M.D. (OWNER)
(480) 897-7070
Entity
Organization
Contact information
Practice address
2127 E BASELINE RD, 104, TEMPE, AZ 85283-1537
(480) 897-7070
(480) 897-2597
Mailing address
2127 E BASELINE RD, 104, TEMPE, AZ 85283-1537
(480) 897-7070
(480) 897-2597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD12426
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669567434
NPI
—
05
—
214510
—
AZ
01
—
AZ0006680
BLUE CROSS BLUE SHIELD
—
Enumeration date
02/06/2007
Last updated
08/22/2020
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