Provider Demographics
NPI:1154591881
Name:THE UNIVERSITY OF ARIZONA
Entity type:Organization
Organization Name:THE UNIVERSITY OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:RACEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-202-2680
Mailing Address - Street 1:3750 E VIA PALOMITA APT 15202
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3359
Mailing Address - Country:US
Mailing Address - Phone:423-202-2680
Mailing Address - Fax:
Practice Address - Street 1:1501 NORTH CAMPBELL AVWNUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:520-626-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81901282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ81901OtherARIZONA MEDICAL BOARD