Provider Demographics
NPI:1013214774
Name:STRUBECK, VERN OSCAR (DO)
Entity Type:Individual
Prefix:DR
First Name:VERN
Middle Name:OSCAR
Last Name:STRUBECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3945 E PARADISE FALLS DRIVE
Mailing Address - Street 2:201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6687
Mailing Address - Country:US
Mailing Address - Phone:520-615-6200
Mailing Address - Fax:520-615-6255
Practice Address - Street 1:3945 E PARADISE FALLS DRIVE
Practice Address - Street 2:201
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6687
Practice Address - Country:US
Practice Address - Phone:520-615-6200
Practice Address - Fax:520-615-6255
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3616207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ671342Medicaid
AZZ164329Medicare PIN