1033183785 NPI number — DR. DEBRA J TOWNSEND M.D.

Table of content: DR. DEBRA J TOWNSEND M.D. (NPI 1033183785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033183785 NPI number — DR. DEBRA J TOWNSEND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOWNSEND
Provider First Name:
DEBRA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POLSON
Provider Other First Name:
DEBRA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033183785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3040 N SWAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-320-1369
Provider Business Mailing Address Fax Number:
520-320-1357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3040 N SWAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-320-1369
Provider Business Practice Location Address Fax Number:
520-320-1357
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  20969 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100010884 . This is a "R.R. MEDICARE PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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