MEDICARE: ROADRUNNER PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1083447692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROADRUNNER PEDIATRICS

Provider Business Mailing Address
First Line	:	12325 E CAPE HORN DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-9328
Country	:	US
Telephone Number	:	520-979-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 S HOUGHTON RD STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85748-6732
Country	:	US
Telephone Number	:	520-979-0550
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MD
Name	:	SANDRA HERRON
Credential	:	MD
Telephone Number	:	520-979-0550

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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Directions to “ROADRUNNER PEDIATRICS ” Practice Location

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