Healthcare Provider Details

I. General information

NPI: 1902897440
Provider Name (Legal Business Name): SCOTT P TANNEHILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 E DEL CAMINO DR SUITE 200
SCOTTSDALE AZ
85258-2351
US

IV. Provider business mailing address

3645 S ROME ST SUITE 116
GILBERT AZ
85297-7336
US

V. Phone/Fax

Practice location:
  • Phone: 480-922-4600
  • Fax: 480-922-5231
Mailing address:
  • Phone: 480-278-8300
  • Fax: 480-922-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number37492
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: