Provider Demographics
NPI:1851349575
Name:CITRON, PHILLIP DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DENNIS
Last Name:CITRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P.
Other - Middle Name:DENNIS
Other - Last Name:CITRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 43130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3130
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:5210 E FARNESS DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2140
Practice Address - Country:US
Practice Address - Phone:520-325-3326
Practice Address - Fax:520-325-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12561207RC0000X
NC23259207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203084Medicaid
AZZ74192Medicare PIN
AZ203084Medicaid