Healthcare Provider Details

I. General information

NPI: 1760697890
Provider Name (Legal Business Name): TROY VIRGIL MAYPA TADURAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TROY M TADURAN D.O.

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 N SILVERBELL RD 101
TUCSON AZ
85745-2675
US

IV. Provider business mailing address

PO BOX 31630
TUCSON AZ
85751-1630
US

V. Phone/Fax

Practice location:
  • Phone: 520-882-0696
  • Fax: 520-624-0024
Mailing address:
  • Phone: 580-784-6200
  • Fax: 520-784-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number05-34185
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number05-34185
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-34185
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: