Healthcare Provider Details

I. General information

NPI: 1093885477
Provider Name (Legal Business Name): ALVERNON ALLERGY AND ASTHMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 E GRANT RD
TUCSON AZ
85716-2742
US

IV. Provider business mailing address

2902 E GRANT RD
TUCSON AZ
85716-2742
US

V. Phone/Fax

Practice location:
  • Phone: 520-322-8361
  • Fax: 520-322-8462
Mailing address:
  • Phone: 520-322-8361
  • Fax: 520-322-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: KUDAGAL MURTHY
Title or Position: CEO
Credential: MD
Phone: 520-322-8361