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General NPI Number Information
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NPI Number | 1104102482
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Entity Type | Organization
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Legal Business Name | SEGO MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 2082 MESQUITE AVE SUITE 106
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6710
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Country | US
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Telephone | 928-680-4233
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Fax | 928-680-6522
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Provider Business Mailing Address
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Address Line | 3361 HILLDALE DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-9062
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Country | US
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Telephone | 928-566-9958
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Fax | 928-680-6522
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | ELIZABETH SMITH-TRYON
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Credential | M.D.
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Telephone | 928-566-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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