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NPI Code Detail

MEDICARE: DR. MOIRA E WRISTEN M.D.

MEDICARE:  DR. MOIRA E WRISTEN  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
1207Q00000XFamily Medicine Physician29118AZ

Other Identifiers

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

General Provider Information

NPI Number : 1689653024
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOIRA E WRISTEN M.D.
Provider Business Mailing Address
First Line : 5055 E BROADWAY BLVD STE A100
Second Line :
City : TUCSON
State : AZ
Zip : 85711-3629
Country : US
Telephone Number : 520-795-4783
Fax Number : 520-547-5797
Provider Business Practice Location Address
First Line : 6565 E CARONDELET DR STE 275
Second Line :
City : TUCSON
State : AZ
Zip : 85710-3529
Country : US
Telephone Number : 520-298-0147
Fax Number : 520-298-7404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 11/08/2023

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Directions to “ DR. MOIRA E WRISTEN M.D.” Practice Location

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