MEDICARE: CAROL DEHASSE MD PC

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	207V00000X	Obstetrics & Gynecology Physician	29765	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427078013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL DEHASSE MD PC

Provider Business Mailing Address
First Line	:	1871 W ORANGE GROVE ROAD
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-1116
Country	:	US
Telephone Number	:	520-498-5000
Fax Number	:	520-498-5011

Provider Business Practice Location Address
First Line	:	1871 W ORANGE GROVE ROAD
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-1116
Country	:	US
Telephone Number	:	520-498-5000
Fax Number	:	520-498-5011

Authorized Official
Title or Position	:	OWNER PROVIDER
Name	:	CAROL M DEHASSE
Credential	:	MD
Telephone Number	:	520-498-5000

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2020

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