| NPI | 1821042904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA FREDRICKS Office Manager 520-792-2170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| Enumeration Date | 2006-05-21 |
| Last Update Date | 2008-07-30 |