Organization
COUNTRY DOCTOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL LEE MANGANELLI SR. (PRESIDENT)
(623) 815-0827
Entity
Organization
Contact information
Practice address
13260 N 94TH DR STE 102, PEORIA, AZ 85381-4242
(623) 815-0827
(623) 875-0325
Mailing address
13260 N 94TH DR STE 102, PEORIA, AZ 85381-4242
(623) 815-0827
(623) 875-0325
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/03/2019
Last updated
04/11/2019
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