Organization
GERALD J TAITAGUE MD PC
Active
Other names
Eagle Rock Health Clinc
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD J TAITAGUE M.D. (PRESIDENT/PHYSICIAN)
(928) 635-1044
Entity
Organization
Contact information
Practice address
117 W ROUTE 66, SUITE 190, WILLIAMS, AZ 86046-2567
(928) 635-1044
(928) 635-1042
Mailing address
117 W ROUTE 66, SUITE 190, WILLIAMS, AZ 86046-2567
(928) 635-1044
(928) 635-1042
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
26182
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-0064151
RAILROAD MEDICARE
AZ
01
—
426503
AHCCCS
AZ
01
—
AZ0865880
BLUE CROSS
AZ
Enumeration date
02/11/2009
Last updated
02/11/2009
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