Provider Demographics
NPI:1063733939
Name:SOUTHERN ARIZONA INFECTIOUS DISEASE SPECIALISTS PLC
Entity type:Organization
Organization Name:SOUTHERN ARIZONA INFECTIOUS DISEASE SPECIALISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-318-9681
Mailing Address - Street 1:5240 E KNIGHT DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2122
Mailing Address - Country:US
Mailing Address - Phone:520-318-9681
Mailing Address - Fax:520-325-6774
Practice Address - Street 1:5240 E KNIGHT DR
Practice Address - Street 2:SUITE 114
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2122
Practice Address - Country:US
Practice Address - Phone:520-318-9681
Practice Address - Fax:520-325-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ536238Medicaid
AZZ139823Medicare PIN