Healthcare Provider Details

I. General information

NPI: 1942355805
Provider Name (Legal Business Name): TODD C. CASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

IV. Provider business mailing address

4741 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

V. Phone/Fax

Practice location:
  • Phone: 520-888-4540
  • Fax: 520-888-4617
Mailing address:
  • Phone: 520-888-4540
  • Fax: 520-888-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number19569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: