MEDICARE: DAVID E NAGATA MD

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	207R00000X	Internal Medicine Physician	50379	AZ

General Provider Information

NPI Number	:	1750371324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID E NAGATA MD

Provider Business Mailing Address
First Line	:	101 TREMONT ST FL 6
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02108-5004
Country	:	US
Telephone Number	:	617-804-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 E THUNDERBIRD RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5306
Country	:	US
Telephone Number	:	602-230-7373
Fax Number	:

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	11/18/2021

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