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General NPI Number Information
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NPI Number | 1497741375
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Entity Type | Individual
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Provider Name | THERESA M MCENTEE MD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 108 ARIZONA ST
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City | BISBEE
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State | AZ
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Zip | 85603-1804
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Country | US
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Telephone | 520-432-1145
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Fax | 520-432-1217
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Provider Business Mailing Address
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Address Line | 310 ARIZONA ST
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City | BISBEE
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State | AZ
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Zip | 85603-1502
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Country | US
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Telephone | 520-432-1145
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Fax | 520-432-1217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26574
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License Number State | AZ
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