Organization
PONDEROSA FAMILY CARE, LLC
Active
Organization
PONDEROSA FAMILY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN P MICHELS (PHYSICIAN)
(928) 468-8603
Entity
Organization
Contact information
Practice address
806 S PONDEROSA ST, PAYSON, AZ 85541-5541
(928) 468-8603
Mailing address
PO BOX 2901, PAYSON, AZ 85547-2901
(928) 468-9280
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29337
AZ
208000000X
Pediatrics Physician
29337
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
703422
—
AZ
Enumeration date
08/09/2010
Last updated
12/05/2014
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