Provider Demographics
NPI:1760697890
Name:TADURAN, TROY VIRGIL MAYPA (DO)
Entity Type:Individual
Prefix:
First Name:TROY VIRGIL
Middle Name:MAYPA
Last Name:TADURAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TROY
Other - Middle Name:M
Other - Last Name:TADURAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:580-784-6200
Mailing Address - Fax:520-784-6109
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2675
Practice Address - Country:US
Practice Address - Phone:520-882-0696
Practice Address - Fax:520-624-0024
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-34185204C00000X, 204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ006444OtherLICENSE
FLOS 9896OtherLICENSE
KS05-34185OtherLICENSE