Healthcare Provider Details

I. General information

NPI: 1144222001
Provider Name (Legal Business Name): ANDREW DAVID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 N BEAVER ST STE 1
FLAGSTAFF AZ
86001-3127
US

IV. Provider business mailing address

1760 E RIVER RD STE 350
TUCSON AZ
85718-5999
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2260
  • Fax: 928-773-2402
Mailing address:
  • Phone: 520-519-7775
  • Fax: 520-519-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number24772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: