| Organization Name: | GOLD CANYON URGENT CARE AND FAMILY MEDICINE |
| NPI Number: | 1861899619 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAITON RUTKOWSKI (CEO MANAGING PARTNER) |
| Mailing Address: | 6820 S Kings Ranch Rd Suite 130 Gold Canyon |
| State: | AZ US |
| Postal Code: | 851182935 |
| Phone Number: | 4809823691 |
| Fax Number: | 4809823692 |
| NPI Enumeration Date: | 11/21/2014 |
| NPI Last Update Date: | 11/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5940 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |