Optimal Mens Center Pllc | |
700 N Estrella Pkwy Ste 145 Goodyear AZ 85338-9329 | |
(602) 678-4625 | |
Not Available |
Full Name | Optimal Mens Center Pllc |
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Speciality | Family Medicine |
Location | 700 N Estrella Pkwy Ste 145, Goodyear, Arizona |
Authorized Official Name and Position | Kerry Knight (PARTNER) |
Authorized Official Contact | 6236404973 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Optimal Mens Center Pllc 700 N Estrella Pkwy Ste 145 Goodyear AZ 85338-9329 Ph: () - | Optimal Mens Center Pllc 700 N Estrella Pkwy Ste 145 Goodyear AZ 85338-9329 Ph: (602) 678-4625 |
NPI Number | 1811535974 |
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Provider Enumeration Date | 12/19/2019 |
Last Update Date | 12/19/2019 |
Medicare PECOS PAC ID | 7113356460 |
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Medicare Enrollment ID | O20200407003439 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811535974 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Nasser Hajaig |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1457324204 PECOS PAC ID: 6800788787 Enrollment ID: I20040708000751 |
Provider Name | Ran Mcbryde |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841760766 PECOS PAC ID: 8123367919 Enrollment ID: I20190221001730 |
Provider Name | Cynthia Dianne Reed |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1750585782 PECOS PAC ID: 0941431514 Enrollment ID: I20190425001668 |
Provider Name | Boris Boguslavskiy |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689075509 PECOS PAC ID: 7719208602 Enrollment ID: I20190607000687 |
Provider Name | Mitzi Schardt |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821267816 PECOS PAC ID: 9537518782 Enrollment ID: I20231213000696 |
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