Healthcare Provider Details

I. General information

NPI: 1336197326
Provider Name (Legal Business Name): STANLEY W. COULTHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 W HOSPITAL DR SUITE 111
TUCSON AZ
85704-7802
US

IV. Provider business mailing address

6565 E CARONDELET DR SUITE 300
TUCSON AZ
85710-2157
US

V. Phone/Fax

Practice location:
  • Phone: 520-575-1272
  • Fax: 520-575-1787
Mailing address:
  • Phone: 520-296-8500
  • Fax: 520-733-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: