Provider Demographics
NPI:1093998270
Name:OBSTETRIX MEDICAL GROUP OF ARIZONA
Entity Type:Organization
Organization Name:OBSTETRIX MEDICAL GROUP OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:520-290-0088
Mailing Address - Street 1:5170 E GLENN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1396
Mailing Address - Country:US
Mailing Address - Phone:520-290-0088
Mailing Address - Fax:520-290-0087
Practice Address - Street 1:5170 E GLENN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1396
Practice Address - Country:US
Practice Address - Phone:520-290-0088
Practice Address - Fax:520-290-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22069207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68660Medicare PIN