Healthcare Provider Details

I. General information

NPI: 1265410351
Provider Name (Legal Business Name): EDWARD TOGNACCI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

PO BOX 15070
SCOTTSDALE AZ
85267-5070
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-6968
  • Fax: 602-839-4144
Mailing address:
  • Phone: 602-839-6968
  • Fax: 602-839-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101015106
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101015106
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: