Mesa Physician Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MESA PHYSICIAN GROUP

Practice address

5151 E Broadway Rd Ste 105
Mesa, AZ 85206-1346

Phone

(480) 809-6587

NPI assigned

May 5, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeremiah Faber

Title

Ceo

Phone

(480) 258-3635

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1104447788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 964",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852990964",
            "telephone_number": "480-366-4489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 E BROADWAY RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061346",
            "telephone_number": "480-809-6587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-05",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "FABER",
        "authorized_official_first_name": "JEREMIAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-258-3635",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mesa Obstetricians & Gynecologists, LTD
• Mesa Outpatient Treatment Center LLC
• Mesa Pain Center LLC
• Mesa Pavilions Dental LLC
• Mesa Physical Medicine PLLC
• Mesa Public Schools
• Mesa Regen Group, LLC
• Mesa Serenity Assisted Living Home LLC
• Mesa Smiles Dentistry
• Mesa Surgery Center LLC

• General Practice Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• General Practice Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.