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Organization

CAVE CREEK CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN SHERMAN GILLIAM MD (MEDICAL DIRECTOR)
(480) 401-1555
Entity
Organization

Contact information

Practice address
2920 E MOHAWK LN STE 101, PHOENIX, AZ 85050-4773
(480) 401-1555
(800) 930-4408
Mailing address
15029 N THOMPSON PEAK PKWY # B111-438, SCOTTSDALE, AZ 85260-2217
(480) 401-1555
(800) 930-4408

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
363LF0000X
Family Nurse Practitioner
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
388615
AZ
05
600874
AZ
Enumeration date
02/02/2019
Last updated
06/11/2019
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