Organization
OPAS & PUANGTONG JUTABHA
Active
Other names
VALLEY MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PUANGTONG JUTABHA M.D. (OWNER)
(928) 927-5454
Entity
Organization
Contact information
Practice address
394 N CENTRAL BLVD, QUARTZSITE, AZ 85346-1499
(928) 927-5454
(927) 928-3303
Mailing address
PO BOX 1499, QUARTZSITE, AZ 85346-1499
(928) 927-5454
(928) 927-3303
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11855
AZ
207R00000X
Internal Medicine Physician
11915
AZ
Other
Enumeration date
12/04/2007
Last updated
04/20/2008
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