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General NPI Number Information
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NPI Number | 1871985366
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Entity Type | Organization
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Legal Business Name | MEDICAL SERVICES OF SOUTHERN ARIZONA
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Dates
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Enumeration Date | 02/20/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 6365 E TANQUE VERDE RD SUITE 230
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City | TUCSON
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State | AZ
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Zip | 85715-3830
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Country | US
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Telephone | 520-886-1071
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Fax | 520-881-3374
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Provider Business Mailing Address
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Address Line | PO BOX 43160
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City | TUCSON
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State | AZ
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Zip | 85733-3160
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Country | US
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Telephone | 520-722-3777
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Fax | 520-296-6224
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Authorized Official
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Title or Position | OWNER
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Name | LE ROI A BAEZ
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Credential | MD
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Telephone | 520-886-1071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 30154
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License Number State | AZ
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