Healthcare Provider Details

I. General information

NPI: 1750895686
Provider Name (Legal Business Name): ARIZONA EP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 E BROADWAY BLVD
TUCSON AZ
85711-3509
US

IV. Provider business mailing address

6030 S RICE AVE STE C
HOUSTON TX
77081-2944
US

V. Phone/Fax

Practice location:
  • Phone: 713-660-0555
  • Fax:
Mailing address:
  • Phone: 713-660-0557
  • Fax: 832-787-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM VO
Title or Position: MANAGER
Credential:
Phone: 713-660-0557