Individual
MR. MICHAEL KEENE DEMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C S
Contact information
Practice address
806 S PONDEROSA ST, PAYSON, AZ 85541-5541
(928) 468-8603
(928) 468-8625
Mailing address
PO BOX 2901, PAYSON, AZ 85547-2901
(928) 468-8603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA 14934
CA
363AM0700X
Medical Physician Assistant
Primary
6422
AZ
Other
Enumeration date
02/27/2007
Last updated
04/19/2017
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