1588648760 NPI number — JEFFREY I SELWYN MD

Table of content: JEFFREY I SELWYN MD (NPI 1588648760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588648760 NPI number — JEFFREY I SELWYN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELWYN
Provider First Name:
JEFFREY
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1588648760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2370 CORPORATE CIR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89074-7760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-910-3950
Provider Business Mailing Address Fax Number:
702-778-2264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5255 E WILLIAMS CIR STE 2020
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:
85711-7454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-392-8400
Provider Business Practice Location Address Fax Number:
520-393-3244
Provider Enumeration Date:
12/01/2005

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:  7825 , 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: AZ0056650 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002000167 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1Z7528 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110046359 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98982 . This is a "PACIFICARE/SECURE HORIZNS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 658936 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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