Healthcare Provider Details

I. General information

NPI: 1821046525
Provider Name (Legal Business Name): TUCSON E.N.T. ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 W. ORANGE GROVE
TUCSON AZ
85704
US

IV. Provider business mailing address

2121 N CRAYCROFT RD BLDG 5
TUCSON AZ
85712-2801
US

V. Phone/Fax

Practice location:
  • Phone: 520-575-1272
  • Fax: 520-575-1789
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 Number
License Number StateAZ

VIII. Authorized Official

Name: KEITH C. SODERBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 520-296-8500