Organization
MOUNTAIN VALLEY PHYSICIAN GROUP, LLC
Active
Other names
Mountain Valley Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MARK STODDARD (MANAGER)
(775) 751-7519
Entity
Organization
Contact information
Practice address
360 S LOLA LN, PAHRUMP, NV 89048-0884
(775) 751-7580
(775) 751-7820
Mailing address
360 S LOLA LN, PAHRUMP, NV 89048-0884
(775) 751-7580
(775) 751-7820
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235327909
—
NV
Enumeration date
10/09/2007
Last updated
08/31/2010
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