Healthcare Provider Details

I. General information

NPI: 1104132166
Provider Name (Legal Business Name): ARIZONA RADIATION THERAPY MANAGEMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 E MCMURRAY BLVD
CASA GRANDE AZ
85122-5404
US

IV. Provider business mailing address

2234 COLONIAL BLVD
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 520-374-2090
  • Fax:
Mailing address:
  • Phone: 239-931-7342
  • Fax: 293-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL E. DOSORETZ
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 239-931-7277