Provider Demographics
NPI:1316903412
Name:TEJADA, ALBERT Q (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:Q
Last Name:TEJADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S 7TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-3957
Mailing Address - Country:US
Mailing Address - Phone:602-824-4550
Mailing Address - Fax:602-824-4555
Practice Address - Street 1:1301 S 7TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3957
Practice Address - Country:US
Practice Address - Phone:602-824-4550
Practice Address - Fax:602-824-4555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288002Medicaid
AZD44570Medicare UPIN
AZ102997Medicare ID - Type UnspecifiedMEDICARE NUMBER