Provider Demographics
NPI:1174723274
Name:MESA FAMILY PHYSICIANS, PLC
Entity type:Organization
Organization Name:MESA FAMILY PHYSICIANS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:480-964-5800
Mailing Address - Street 1:1425 S GREENFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5505
Mailing Address - Country:US
Mailing Address - Phone:480-964-5800
Mailing Address - Fax:480-632-5923
Practice Address - Street 1:1425 S GREENFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5505
Practice Address - Country:US
Practice Address - Phone:480-964-5800
Practice Address - Fax:480-644-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14219207Q00000X
AZ13293207Q00000X
AZ10054207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG17872Medicare UPIN
AZD86735Medicare UPIN
AZD37085Medicare UPIN
AZD44390Medicare UPIN