Healthcare Provider Details

I. General information

NPI: 1477007136
Provider Name (Legal Business Name): REBECCA THIEDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 E BOSTON ST
GILBERT AZ
85295-6221
US

IV. Provider business mailing address

1501 N CAMPBELL AVE
TUCSON AZ
85724-5035
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-0085
  • Fax:
Mailing address:
  • Phone: 520-626-6349
  • Fax: 805-569-8358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number63555
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: