Basic Information
| Provider Information | |||||||||
| NPI: | 1669420360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TUCSON E.N.T. ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 N CRAYCROFT RD BLDG 5 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202968500 | ||||||||
| FaxNumber: | 5207332389 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 N CRAYCROFT RD BLDG 5 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202968500 | ||||||||
| FaxNumber: | 5207332389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | SODERBERG | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5202968500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.