Provider Demographics
NPI:1174504930
Name:TAMBURRO, LARRY S (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:TAMBURRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6197
Mailing Address - Country:US
Mailing Address - Phone:480-899-2900
Mailing Address - Fax:480-899-0681
Practice Address - Street 1:1455 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6197
Practice Address - Country:US
Practice Address - Phone:480-899-2900
Practice Address - Fax:480-899-0681
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WDCBG05Medicare ID - Type Unspecified
G46194Medicare UPIN