Basic Information
| Provider Information | |||||||||
| NPI: | 1568592558 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TUCSON VASCULAR SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 85727 | ||||||||
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| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857545727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206288686 | ||||||||
| FaxNumber: | 5202970626 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 W ST. MARY'S RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206281400 | ||||||||
| FaxNumber: | 5206284863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CUBBLER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | C.O.O. | ||||||||
| AuthorizedOfficialTelephone: | 5206288686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.