Provider Demographics
NPI:1699750786
Name:WESTERN ARIZONA RADIOLOGY
Entity type:Organization
Organization Name:WESTERN ARIZONA RADIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-767-2222
Mailing Address - Street 1:6261 N LA CHOLLA BLVD
Mailing Address - Street 2:#151
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3565
Mailing Address - Country:US
Mailing Address - Phone:520-352-7600
Mailing Address - Fax:520-352-7610
Practice Address - Street 1:6261 N LA CHOLLA BLVD
Practice Address - Street 2:#151
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3565
Practice Address - Country:US
Practice Address - Phone:520-352-7600
Practice Address - Fax:520-352-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ233532085R0202X
AZ248932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22518Medicare UPIN
F80531Medicare UPIN
AZ79510Medicare ID - Type Unspecified