1164425252 NPI number — TEDD MARK GOLDFINGER D.O.

Table of content: (NPI 1114795531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164425252 NPI number — TEDD MARK GOLDFINGER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDFINGER
Provider First Name:
TEDD
Provider Middle Name:
MARK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164425252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6320 N LA CHOLLA BLVD STE 300
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:
85741-3552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-545-0953
Provider Business Mailing Address Fax Number:
520-545-0954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6320 N LA CHOLLA BLVD STE 300
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:
85741-3552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-545-0953
Provider Business Practice Location Address Fax Number:
520-545-0954
Provider Enumeration Date:
05/23/2005

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: 207RC0000X , with the licence number:  02198 , 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: 259665 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00132740 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 005502300 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 10076419 . This is a "PPO NEXT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5016425 . This is a "CCN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 100663 . This is a "ONE HEALTH PLAN OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1413 . This is a "ARIZONA MEDICAL NETWORK" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2591480 . This is a "GHI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4063355 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 9827534 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0562140 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52985 . This is a "FIRST HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0860250 . This is a "BCBS OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z2241 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 25-00025 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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