NPI 1235416918

Gregg P Standage MD

Organisation Specialist Prescott, AZ

Practice location

Address: 705 W Hillside Ave, Prescott, AZ 86301-1938
Phone: (928) 348-1374
Fax: (928) 348-1375
Mailing address: 1515 S 20th Ave, Safford, AZ 85546-4009

Authorised official

Name: Gregg P Standage
Title: MD
Phone: (928) 348-1374

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 22289 (AZ)

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Registry record

NPI: 1235416918
Entity type: Organization
NPI issued: 9 Nov 2011
Record last updated: 27 Dec 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.