Organization Name: | GREGG P STANDAGE MD |
NPI Number: | 1235416918 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGG P STANDAGE (MD) |
Mailing Address: | 705 W Hillside Ave Prescott |
State: | AZ US |
Postal Code: | 863011938 |
Phone Number: | 9283481374 |
Fax Number: | 9283481375 |
NPI Enumeration Date: | 11/09/2011 |
NPI Last Update Date: | 12/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 22289 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |