=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023001567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROY R. GETTEL MDPLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1980 W HOSPITAL DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-7802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-742-0900
-----------------------------------------------------
Fax | 520-742-1371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1980 W HOSPITAL DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-7804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-742-0900
-----------------------------------------------------
Fax | 520-742-1371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. ROY RICHARD GETTEL
-----------------------------------------------------
Credential | M.D. PLLC
-----------------------------------------------------
Telephone | 520-742-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 11015
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------