Provider Demographics
NPI:1689704090
Name:CUZNER, GORDON J (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:J
Last Name:CUZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1669 W INA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1976
Mailing Address - Country:US
Mailing Address - Phone:520-573-0966
Mailing Address - Fax:520-784-7226
Practice Address - Street 1:1460 W VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6001
Practice Address - Country:US
Practice Address - Phone:520-573-0966
Practice Address - Fax:520-573-3930
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0455581OtherCIGNA
AZ271239002Medicaid
AZZ4771OtherHEALTH NET
AZ0455581OtherCIGNA