MEDICARE: CHARLES MARK BAZZELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	36023	AZ

General Provider Information

NPI Number	:	1205923729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MARK BAZZELL MD

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:	POB 245114
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:	520-626-7221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 E ELVIRA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-7124
Country	:	US
Telephone Number	:	520-874-4024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	02/10/2012

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Directions to “ CHARLES MARK BAZZELL MD” Practice Location

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