Gerald J Taitague MD PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

26182 Issued in AZ

Legal business name

GERALD J TAITAGUE MD PC

Doing business as

Eagle Rock Health Clinc

Practice address

117 W Route 66
Suite 190
Williams, AZ 86046-2567

Phone

(928) 635-1044

Fax

(928) 635-1042

NPI assigned

Feb 11, 2009

Last updated

Feb 11, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gerald J Taitague, M.D.

Title

President/Physician

Phone

(928) 635-1044

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Eagle Rock Health Clinc Doing business as

Locations

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1689813834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W ROUTE 66",
            "address_2": "SUITE 190",
            "city": "WILLIAMS",
            "state": "AZ",
            "postal_code": "860462567",
            "telephone_number": "928-635-1044",
            "fax_number": "928-635-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W ROUTE 66",
            "address_2": "SUITE 190",
            "city": "WILLIAMS",
            "state": "AZ",
            "postal_code": "860462567",
            "telephone_number": "928-635-1044",
            "fax_number": "928-635-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD J TAITAGUE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "TAITAGUE",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "928-635-1044",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "26182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "01-0064151",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "426503",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "AZ0865880",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Rock Health Clinc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Leslie Farrell, M.ED.,NCC
• Erin Felton, MD
• Nicole Fisher, RDH
• Michael Jeffrey Franklin, PHARMD
• Dana Serene Ger, M.D.
• Isabel Goel
• Brandon Anthony Hancz, PTA
• Ethan Jared Hansen, D.P.T.
• Theresa Hawks, PHARMD
• Elizabeth Dawn Haws, FNP-C

• Primary Care Clinic/Center in Williams, AZ
• Providers in Williams, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2009; 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.