Provider Demographics
NPI:1568516318
Name:ALLERGY ASSOCIATES OF TUCSON PC
Entity Type:Organization
Organization Name:ALLERGY ASSOCIATES OF TUCSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAGELIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-325-5701
Mailing Address - Street 1:2960 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1912
Mailing Address - Country:US
Mailing Address - Phone:520-325-5701
Mailing Address - Fax:
Practice Address - Street 1:2960 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1912
Practice Address - Country:US
Practice Address - Phone:520-325-5701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6407207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ206905Medicaid
ARE00232Medicare UPIN