Healthcare Provider Details

I. General information

NPI: 1649941758
Provider Name (Legal Business Name): TUCSON SPORTS MEDICINE AND ORTHOPEDIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 W ANKLAM RD STE 102
TUCSON AZ
85745-2660
US

IV. Provider business mailing address

4880 N AVENIDA DE FRANELAH
TUCSON AZ
85749-8721
US

V. Phone/Fax

Practice location:
  • Phone: 520-396-4798
  • Fax:
Mailing address:
  • Phone: 520-869-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RORY GARGUS
Title or Position: OWNER
Credential:
Phone: 520-869-4909