Organization
GILA VALLEY MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD D BROOKSHER MD (OWNER)
(928) 344-6263
Entity
Organization
Contact information
Practice address
1951 WEST 25TH STREET, SUITE D, YUMA, AZ 85364
(928) 344-6263
(928) 785-9572
Mailing address
1951 WEST 25TH STREET, SUITE D, YUMA, AZ 85364
(928) 344-6263
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20396
AZ
363A00000X
Physician Assistant
2125
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
076275001
AACCS
—
Enumeration date
04/12/2007
Last updated
05/07/2008
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