Healthcare Provider Details

I. General information

NPI: 1972267896
Provider Name (Legal Business Name): IRONWOOD HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9241 N RALEIGH DR
TUCSON AZ
85704-3628
US

IV. Provider business mailing address

9241 N RALEIGH DR
TUCSON AZ
85704-3628
US

V. Phone/Fax

Practice location:
  • Phone: 520-225-7006
  • Fax:
Mailing address:
  • Phone: 520-225-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP JEFFERY COOK
Title or Position: MEMBER
Credential: NP
Phone: 520-225-7006