Healthcare Provider Details

I. General information

NPI: 1588034268
Provider Name (Legal Business Name): TUCSON SHOULDER ELBOW & HAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3972 N CAMPBELL AVE
TUCSON AZ
85719-1460
US

IV. Provider business mailing address

5402 N PLACITA GATO MONTES
TUCSON AZ
85718-6049
US

V. Phone/Fax

Practice location:
  • Phone: 520-639-9009
  • Fax:
Mailing address:
  • Phone: 520-639-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number29611
License Number StateAZ

VIII. Authorized Official

Name: JOEL D THOMPSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 520-639-9009