Basic Information
| Provider Information | |||||||||
| NPI: | 1417486465 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IORA SENIOR HEALTH, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | IORA PRIMARY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 TREMONT STREET, 6TH FLOOR | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174544672 | ||||||||
| FaxNumber: | 6177017740 | ||||||||
| Practice Location | |||||||||
| Address1: | 13940 W. MEEKER BLVD. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233779929 | ||||||||
| FaxNumber: | 8446237172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2017 | ||||||||
| LastUpdateDate: | 06/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | MUNK | ||||||||
| AuthorizedOfficialFirstName: | MARC-DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6174544672 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.