Basic Information
| Provider Information | |||||||||
| NPI: | 1013214774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRUBECK | ||||||||
| FirstName: | VERN | ||||||||
| MiddleName: | OSCAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3945 E PARADISE FALLS DRIVE | ||||||||
| Address2: | 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206156200 | ||||||||
| FaxNumber: | 5206156255 | ||||||||
| Practice Location | |||||||||
| Address1: | 3945 E PARADISE FALLS DRIVE | ||||||||
| Address2: | 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206156200 | ||||||||
| FaxNumber: | 5206156255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2011 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 3616 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 671342 | 05 | AZ | MEDICAID |