Basic Information
| Provider Information | |||||||||
| NPI: | 1336703180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAUSE | ||||||||
| FirstName: | JUSTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3950 S COUNTRY CLUB RD STE 130 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857142203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208744800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3950 S COUNTRY CLUB RD STE 130 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857142203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208744800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2019 | ||||||||
| LastUpdateDate: | 04/26/2019 | ||||||||
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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 | 207Q00000X | R77469 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.