MEDICARE: DR. RICHARD A HOSHAW M.D.

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	207N00000X	Dermatology Physician	11397	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	237439	OTHER	AZ	AHCCCS
2	11397	OTHER	AZ	STATE

General Provider Information

NPI Number	:	1336121854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A HOSHAW M.D.

Provider Business Mailing Address
First Line	:	2375 N WYATT DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2152
Country	:	US
Telephone Number	:	520-881-8600
Fax Number	:	520-881-8163

Provider Business Practice Location Address
First Line	:	2375 N WYATT DR
Second Line	:	STE109
City	:	TUCSON
State	:	AZ
Zip	:	85712-2152
Country	:	US
Telephone Number	:	520-881-8600
Fax Number	:	520-881-8163

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/09/2007

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