Organization
SHANNON GRAY
Active
Other names
VISTA MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHANNON GRAY (ADMINISTRATOR/OWNER)
(480) 983-4200
Entity
Organization
Contact information
Practice address
1111 S STAPLEY DR, SUITE 111, MESA, AZ 85204-5059
(480) 398-1220
(480) 398-1230
Mailing address
212 W SUPERSTITION BLVD, SUITE 101, APACHE JUNCTION, AZ 85120-4127
(480) 983-4200
(480) 983-4317
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36286
AZ
Other
Enumeration date
03/01/2010
Last updated
03/01/2010
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