Basic Information
| Provider Information | |||||||||
| NPI: | 1679583306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA MEDICAL SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1460 W VALENCIA RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857466001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205730966 | ||||||||
| FaxNumber: | 5205735882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1460 W VALENCIA RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857466001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205730966 | ||||||||
| FaxNumber: | 5205735882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | WADLEIGH | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5205730966 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1940 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.