Healthcare Provider Details

I. General information

NPI: 1043278732
Provider Name (Legal Business Name): LAURENE E GOLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 N SWAN ROAD CAMP LOWELL MEDICAL SPECIALISTS
TUCSON AZ
85712
US

IV. Provider business mailing address

5055 E BROADWAY BLVD SUITE A-100 - ARIZONA COMMUNITY PHYSICIAN PC
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-9700
  • Fax: 520-547-9719
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21124
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: