Basic Information
| Provider Information | |||||||||
| NPI: | 1689704090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUZNER | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1669 W INA RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205730966 | ||||||||
| FaxNumber: | 5207847226 | ||||||||
| Practice Location | |||||||||
| Address1: | 1460 W VALENCIA RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857466001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205730966 | ||||||||
| FaxNumber: | 5205733930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 04/18/2014 | ||||||||
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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 | 17172 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0455581 | 01 | AZ | CIGNA | OTHER | 271239002 | 05 | AZ | MEDICAID | Z4771 | 01 | AZ | HEALTH NET | OTHER |