Organization
MESA PHYSICIAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMIAH FABER (CEO)
(480) 258-3635
Entity
Organization
Contact information
Practice address
5151 E BROADWAY RD STE 105, MESA, AZ 85206-1346
(480) 809-6587
Mailing address
PO BOX 964, GILBERT, AZ 85299-0964
(480) 366-4489
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/05/2020
Last updated
05/06/2020
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