Organization
FAMILY PRACTICE CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES E MYERS DO (PRESIDENT)
(602) 278-4930
Entity
Organization
Contact information
Practice address
3306 W ROOSEVELT ST, STE A, PHOENIX, AZ 85009-3404
(602) 278-4930
Mailing address
3306 W ROOSEVELT ST, STE A, PHOENIX, AZ 85009-3404
(602) 278-4930
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1239
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261131
—
AZ
Enumeration date
08/18/2007
Last updated
09/28/2007
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