Provider Demographics
NPI:1790019909
Name:UNIVERSITY OF ARIZONA DEPARTMENT OF SURGERY
Entity Type:Organization
Organization Name:UNIVERSITY OF ARIZONA DEPARTMENT OF SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ASSISTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:FULCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-694-6000
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:P.O. BOX 245058
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-626-7747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital