Organization
MOUNTAIN PEDIATRICS CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD TODHUNTER M.D. (OWNER)
(928) 537-3500
Entity
Organization
Contact information
Practice address
5171 CUB LAKE ROAD, SUITE B230, SHOW LOW, AZ 85901-7888
(928) 537-3500
(928) 537-3552
Mailing address
5171 CUB LAKE RD, SUITE B230, SHOW LOW, AZ 85901-7888
(928) 537-3500
(928) 537-3552
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
31953
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
799942
—
AZ
Enumeration date
12/20/2006
Last updated
08/22/2020
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