Healthcare Provider Details

I. General information

NPI: 1952309130
Provider Name (Legal Business Name): CARL STANLEY KANUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N WILMOT RD SUITE 305
TUCSON AZ
85711-2618
US

IV. Provider business mailing address

310 N WILMOT RD SUITE 305
TUCSON AZ
85711-2618
US

V. Phone/Fax

Practice location:
  • Phone: 520-885-0823
  • Fax: 520-885-6337
Mailing address:
  • Phone: 520-885-0823
  • Fax: 520-885-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8892
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: