Organization
PETRIFIED FOREST MEDICAL CENTER. INC.
Active
Other names
Petrified Forest Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW L MAESTAS MD (OWNER)
(928) 524-3913
Entity
Organization
Contact information
Practice address
500 E IOWA ST, HOLBROOK, AZ 86025-2750
(928) 524-3913
Mailing address
500 E IOWA ST, HOLBROOK, AZ 86025-2750
(928) 524-3913
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21878
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149585
—
AZ
Enumeration date
08/05/2007
Last updated
12/17/2012
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