Healthcare Provider Details

I. General information

NPI: 1023141264
Provider Name (Legal Business Name): WESTERN NEUROSURGERY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6567 E CARONDELET DR STE 305
TUCSON AZ
85710-2156
US

IV. Provider business mailing address

6567 E CARONDELET DR STE 305
TUCSON AZ
85710-2156
US

V. Phone/Fax

Practice location:
  • Phone: 520-881-8400
  • Fax:
Mailing address:
  • Phone: 520-881-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT P GOLDFARB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 520-881-8400