Provider Demographics
NPI:1295085678
Name:CASA GRANDE FAMILY PHYSICIANS PC
Entity type:Organization
Organization Name:CASA GRANDE FAMILY PHYSICIANS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANICETO
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-836-3600
Mailing Address - Street 1:1760 E FLORENCE BLVD
Mailing Address - Street 2:STE 260
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4764
Mailing Address - Country:US
Mailing Address - Phone:520-836-3600
Mailing Address - Fax:520-836-6757
Practice Address - Street 1:1760 E FLORENCE BLVD STE 260
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4769
Practice Address - Country:US
Practice Address - Phone:520-836-3600
Practice Address - Fax:520-836-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty