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General NPI Number Information
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NPI Number | 1710180401
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Entity Type | Organization
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Legal Business Name | ERIK DE JONGHE MD PC
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 1601 W ST MARYS RD
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City | TUCSON
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State | AZ
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Zip | 85745
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Country | US
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Telephone | 520-872-7383
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Fax | 520-872-7969
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Provider Business Mailing Address
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Address Line | 2202 N FORBES BLVD
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City | TUCSON
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State | AZ
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Zip | 85745-1412
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Country | US
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Telephone | 520-872-7383
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Fax | 520-872-7969
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KIRSTEN FREDERIKSEN
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Credential | MD
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Telephone | 520-615-0318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 31026
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License Number State | AZ
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