Organization
NORTH VALLEY FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN W ELLIS DO (PRESIDENT)
(623) 322-4991
Entity
Organization
Contact information
Practice address
6320 W UNION HILLS DR STE 2800B, GLENDALE, AZ 85308-1380
(623) 322-4991
(623) 322-9568
Mailing address
6320 W UNION HILLS DR STE 2800B, GLENDALE, AZ 85308-1380
(623) 322-4991
(623) 322-9568
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-646940-R
STATE LICENSE
AZ
Enumeration date
04/06/2006
Last updated
06/07/2023
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