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NPI Code Detail

MEDICARE: TUCSON E.N.T. ASSOCIATES, P.C.

MEDICARE: TUCSON E.N.T. ASSOCIATES, P.C.
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
1207Y00000XOtolaryngology PhysicianAZ

General Provider Information

NPI Number : 1669420360
Entity Type Code : Organization
Provider Name (Legal Business Name) : TUCSON E.N.T. ASSOCIATES, P.C.
Provider Business Mailing Address
First Line : 2121 N CRAYCROFT RD BLDG 5
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2801
Country : US
Telephone Number : 520-296-8500
Fax Number : 520-733-2389
Provider Business Practice Location Address
First Line : 2121 N CRAYCROFT RD BLDG 5
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2801
Country : US
Telephone Number : 520-296-8500
Fax Number : 520-733-2389
Authorized Official
Title or Position : PRESIDENT
Name : KEITH C. SODERBERG
Credential : M.D.
Telephone Number : 520-296-8500
Provider Enumeration Date : 05/04/2006
Last Update Date : 12/04/2020

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