Provider Demographics
NPI:1962795377
Name:TAVEL, HEIDI A (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:TAVEL
Suffix:
Gender:F
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 1:2810 N SWAN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6305
Mailing Address - Country:US
Mailing Address - Phone:520-324-2030
Mailing Address - Fax:520-445-6019
Practice Address - Street 1:2810 N SWAN RD
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6305
Practice Address - Country:US
Practice Address - Phone:520-324-2030
Practice Address - Fax:520-445-6019
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ50109207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ038641Medicaid
AZZ178175OtherMEDICARE ID