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NPI Code Detail

MEDICARE: GREGORY C ETIENNE PA

MEDICARE: GREGORY C ETIENNE PA
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
1363AM0700XMedical Physician Assistant154PR
2363A00000XPhysician Assistant8320AZ

General Provider Information

NPI Number : 1497384168
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY C ETIENNE PA
Provider Business Mailing Address
First Line : 4834 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85711-3610
Country : US
Telephone Number : 480-223-9314
Fax Number : 480-923-9155
Provider Business Practice Location Address
First Line : 444 W OSBORN RD STE 200
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-3817
Country : US
Telephone Number : 480-223-9314
Fax Number : 480-923-9155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2020
Last Update Date : 02/07/2025

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Directions to “ GREGORY C ETIENNE PA” Practice Location

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