Provider Demographics
NPI:1417945833
Name:NATRAJAN, REBECCA A (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:NATRAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6365 E TANQUE VERDE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3830
Mailing Address - Country:US
Mailing Address - Phone:520-886-1055
Mailing Address - Fax:520-886-6438
Practice Address - Street 1:6365 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3830
Practice Address - Country:US
Practice Address - Phone:520-886-1055
Practice Address - Fax:520-886-6438
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21355207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ309759Medicaid
AZ309759Medicaid
AZF72178Medicare UPIN