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NPI Code Detail

MEDICARE: BURT A STANGA MD

MEDICARE:   BURT A STANGA  MD
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
12080A0000XPediatric Adolescent Medicine Physician33756IA
2208000000XPediatrics Physician32693AZ

General Provider Information

NPI Number : 1417929753
Entity Type Code : Individual
Provider Name (Legal Business Name) : BURT A STANGA MD
Provider Business Mailing Address
First Line : PO BOX 87812
Second Line :
City : TUCSON
State : AZ
Zip : 85754-7812
Country : US
Telephone Number : 520-743-3550
Fax Number :
Provider Business Practice Location Address
First Line : 1852 N MASTICK WAY
Second Line :
City : NOGALES
State : AZ
Zip : 85621-1063
Country : US
Telephone Number : 520-375-6007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 02/24/2009

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Directions to “ BURT A STANGA MD” Practice Location

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