Provider Demographics
NPI:1003031931
Name:IRONWOOD GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:IRONWOOD GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIZWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-722-3777
Mailing Address - Street 1:PO BOX 43100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3100
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:SUITE 255
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2675
Practice Address - Country:US
Practice Address - Phone:520-722-3777
Practice Address - Fax:520-296-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27577207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ274981Medicaid
AZ274981Medicaid
AZ274981Medicaid
AZ=========OtherTIN