Provider Demographics
NPI:1144762238
Name:PATHWAYS MEDICAL PARTNERS
Entity Type:Organization
Organization Name:PATHWAYS MEDICAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORBON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-635-9103
Mailing Address - Street 1:PO BOX 65177
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-5177
Mailing Address - Country:US
Mailing Address - Phone:520-635-9103
Mailing Address - Fax:520-336-9179
Practice Address - Street 1:1700 E RIVER RD
Practice Address - Street 2:#65177
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85728-5177
Practice Address - Country:US
Practice Address - Phone:520-635-9103
Practice Address - Fax:520-336-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty