Healthcare Provider Details

I. General information

NPI: 1891899530
Provider Name (Legal Business Name): DUANE F DYSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N CRAYCROFT RD STE 150
TUCSON AZ
85712-2816
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-202-3488
  • Fax: 520-202-3486
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41317
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: