Organization
SUN ARIZONA MEDICAL GROUP P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASMINE SRA MD (PHYSICIAN)
(480) 372-5081
Entity
Organization
Contact information
Practice address
13943 N 91ST AVE STE A102, PEORIA, AZ 85381-3688
(480) 372-5081
(480) 398-7618
Mailing address
13943 N 91ST AVE STE A102, PEORIA, AZ 85381-3688
(480) 372-5081
(480) 398-7618
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3323482
CIGNA/GREAT WEST
AZ
01
—
944482
AHCCCS/MEDICAID
AZ
Enumeration date
09/04/2014
Last updated
12/04/2024
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