Graduated: 1986
NPI: 1861586398
Practice Locations (2)
BANNER HOSPITAL BASED PHYSICIANS ARIZONA LLC
1400 S DOBSON RD
MESA, AZ 852024707
4804123000
DHEW IND HLTH SV HLTH SVS AND MNTL HLTH ADM
4212 N 16TH ST
PHOENIX, AZ 850165319
6022631200
Source: CMS National Downloadable File, September 2026.