Healthcare Provider Details

I. General information

NPI: 1427078013
Provider Name (Legal Business Name): CAROL DEHASSE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 W ORANGE GROVE ROAD SUITE 101
TUCSON AZ
85704-1116
US

IV. Provider business mailing address

1871 W ORANGE GROVE ROAD SUITE 101
TUCSON AZ
85704-1116
US

V. Phone/Fax

Practice location:
  • Phone: 520-498-5000
  • Fax: 520-498-5011
Mailing address:
  • Phone: 520-498-5000
  • Fax: 520-498-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29765
License Number StateAZ

VIII. Authorized Official

Name: CAROL M DEHASSE
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 520-498-5000