Organization
GRAND CANYON MEDICAL IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM R BURGE MD (MANAGING PARTNER)
(714) 754-5800
Entity
Organization
Contact information
Practice address
3269 STOCKTON HILL RD, KINGMAN, AZ 86401-3619
(928) 757-0620
Mailing address
PO BOX 73878, SAN CLEMENTE, CA 92673-0130
(714) 754-5804
(714) 754-6800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
AZ
Other
Enumeration date
03/08/2007
Last updated
07/12/2007
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