Healthcare Provider Details

I. General information

NPI: 1013012699
Provider Name (Legal Business Name): IVY L SCHWARTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N DODGE BLVD SUITE 100
TUCSON AZ
85716-2671
US

IV. Provider business mailing address

3211 W WESTWOOD PL
TUCSON AZ
85745-1550
US

V. Phone/Fax

Practice location:
  • Phone: 520-618-8747
  • Fax: 520-882-5676
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number13989
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: