Healthcare Provider Details

I. General information

NPI: 1417881871
Provider Name (Legal Business Name): DR. TRISTON MABRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

4500 N VIA ENTRADA APT 122
TUCSON AZ
85718-7606
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-2000
  • Fax:
Mailing address:
  • Phone: 520-664-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR82831
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: