Healthcare Provider Details

I. General information

NPI: 1275709586
Provider Name (Legal Business Name): NATHAN BRANDT PRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724
US

IV. Provider business mailing address

PO BOX 245073
TUCSON AZ
85724-5073
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-6507
  • Fax: 520-626-5652
Mailing address:
  • Phone: 520-626-6507
  • Fax: 205-626-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30133
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41130
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number81943
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number41130
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: