1548264450 NPI number — ASPEN I RALPH DO

Table of content: ASPEN I RALPH DO (NPI 1548264450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548264450 NPI number — ASPEN I RALPH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RALPH
Provider First Name:
ASPEN
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1548264450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6060 N FOUNTAIN PLAZA DR STE 270
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:
85704-7873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-229-2578
Provider Business Mailing Address Fax Number:
520-229-2561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6060 N FOUNTAIN PLAZA DR STE 270
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:
85704-7873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-229-2578
Provider Business Practice Location Address Fax Number:
520-229-2561
Provider Enumeration Date:
06/08/2005

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: 207R00000X , with the licence number:  3787 , 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: 2Z1203 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0758740 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3122834 . This is a "AETNA HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 860750942 . This is a "ARIZONA FOUNDATION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0402296 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2192402 . This is a "FIRST HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 8671843002 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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