| Vital4men Llc | |
|
7707 W Deer Valley Rd 115 Peoria AZ 85382-2101 | |
| (623) 218-1515 | |
| Not Available |
| Full Name | Vital4men Llc |
|---|---|
| Speciality | General Practice |
| Location | 7707 W Deer Valley Rd, Peoria, Arizona |
| Authorized Official Name and Position | Todd Dishon (MANAGING PARTNER) |
| Authorized Official Contact | 6232181515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital4men Llc 7707 W Deer Valley Rd 115 Peoria AZ 85382-2101 Ph: (623) 218-1515 | Vital4men Llc 7707 W Deer Valley Rd 115 Peoria AZ 85382-2101 Ph: (623) 218-1515 |
| NPI Number | 1639443757 |
|---|---|
| Provider Enumeration Date | 03/07/2012 |
| Last Update Date | 07/10/2012 |
| Medicare PECOS PAC ID | 5799940003 |
|---|---|
| Medicare Enrollment ID | O20120711000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639443757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Donald R Middleton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306909205 PECOS PAC ID: 6507841962 Enrollment ID: I20040621000591 |
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