Healthcare Provider Details

I. General information

NPI: 1942950183
Provider Name (Legal Business Name): TXURSELFMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 MEADE ST
DENVER CO
80204-1552
US

IV. Provider business mailing address

405 E WETMORE RD STE 117 # 230
TUCSON AZ
85705-1792
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3379
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC MARTIN
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 702-453-3799