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>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1801123948

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1852 N MASTICK WAY  NOGALES, AZ 85621-1063 US
Tel: 520-281-1550  Fax: 520-281-1112

Contact information for business:
825 N GRAND AVE STE 100  NOGALES, AZ 85621-1061 US
Tel: 520-281-1550  Fax: 520-281-1112

Registration Information:
NPI: 1801123948
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine

Legacy codes, insurance codes and state license numbers:



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