Healthcare Provider Details

I. General information

NPI: 1407840044
Provider Name (Legal Business Name): TUSHAR N PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 N CAMPBELL AVE STE 110
TUCSON AZ
85719-2380
US

IV. Provider business mailing address

3390 N CAMPBELL AVE STE 110
TUCSON AZ
85719-2380
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-7650
  • Fax: 520-325-1622
Mailing address:
  • Phone: 520-795-7650
  • Fax: 520-325-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number28754
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: