Provider Demographics
NPI:1194754820
Name:MORETZ, ANTHONY J (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:MORETZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 E TORONTO ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2342
Mailing Address - Country:US
Mailing Address - Phone:520-955-2377
Mailing Address - Fax:
Practice Address - Street 1:1775 W SAINT MARYS RD
Practice Address - Street 2:SUITE 116
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2696
Practice Address - Country:US
Practice Address - Phone:520-624-2471
Practice Address - Fax:520-882-7469
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2487363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ70701Medicare PIN