Provider Demographics
NPI:1649216300
Name:SMALL, JOSEPH M (DO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:SMALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3982 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719
Mailing Address - Country:US
Mailing Address - Phone:520-795-1581
Mailing Address - Fax:520-323-9562
Practice Address - Street 1:3982 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-795-1581
Practice Address - Fax:520-323-9562
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1255207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
209727OtherAZ BILLING IDENTIFIER
WCJAT01Medicare ID - Type Unspecified
E20689Medicare UPIN