MEDICARE: IRENE K TAW 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	2085R0205X	Radiological Physics Physician	26257	AZ
2	2085R0001X	Radiation Oncology Physician	26257	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	418774	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1891760294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE K TAW MD

Provider Business Mailing Address
First Line	:	PO BOX 910221
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-0221
Country	:	US
Telephone Number	:	520-519-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 W SACK DR STE 105
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7106
Country	:	US
Telephone Number	:	623-888-5400
Fax Number	:

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	03/18/2022

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