Healthcare Provider Details

I. General information

NPI: 1649275645
Provider Name (Legal Business Name): PAUL SK TAMANAHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E GUADALUPE RD STE 109
GILBERT AZ
85234
US

IV. Provider business mailing address

2545 W FRYE RD STE 9
CHANDLER AZ
85224-6273
US

V. Phone/Fax

Practice location:
  • Phone: 480-505-4475
  • Fax: 480-505-4252
Mailing address:
  • Phone: 480-505-4258
  • Fax: 480-275-8346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22014
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: