Provider Demographics
NPI:1700856069
Name:TENNYSON, HEATH CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:CHARLES
Last Name:TENNYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6280
Mailing Address - Country:US
Mailing Address - Phone:480-273-8503
Mailing Address - Fax:480-214-9929
Practice Address - Street 1:395 N SILVERBELL RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2719
Practice Address - Country:US
Practice Address - Phone:740-446-5135
Practice Address - Fax:740-446-5982
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.120409207Y00000X
IN1057676A207Y00000X
AZ49866207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ970673Medicaid
OH0078122Medicaid
WV3810024975Medicaid