Healthcare Provider Details

I. General information

NPI: 1831138569
Provider Name (Legal Business Name): KEVIN L POUNDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-0414
  • Fax: 520-742-4063
Mailing address:
  • Phone: 520-547-4906
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: