MEDICARE: ALLERGY ASSOCIATES OF TUCSON PC

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	207KA0200X	Allergy Physician	6407	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568516318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY ASSOCIATES OF TUCSON PC

Provider Business Mailing Address
First Line	:	2960 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-325-5701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-325-5701
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. REUBEN G WAGELIE
Credential	:	M.D.
Telephone Number	:	520-325-5701

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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