Provider Demographics
NPI:1346215589
Name:TARLIAN, HENRY S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:S
Last Name:TARLIAN
Suffix:JR
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 1:7165 E UNIVERSITY DR STE 187
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-6415
Mailing Address - Country:US
Mailing Address - Phone:480-668-5000
Mailing Address - Fax:480-428-8593
Practice Address - Street 1:7165 E UNIVERSITY DR STE 183
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6415
Practice Address - Country:US
Practice Address - Phone:480-668-5000
Practice Address - Fax:480-668-5065
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ313718Medicaid
AZAZ0778560OtherBC/BS OF ARIZONA
AZ313718Medicaid
AZAZ0778560OtherBC/BS OF ARIZONA
AZ313718Medicaid