Provider Demographics
NPI:1851528657
Name:THEODORE MARK CWYNAR, MD, PC
Entity Type:Organization
Organization Name:THEODORE MARK CWYNAR, MD, PC
Other - Org Name:T. MARK CWYNAR, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CWYNAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-946-5656
Mailing Address - Street 1:7331 E OSBORN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6422
Mailing Address - Country:US
Mailing Address - Phone:480-946-5656
Mailing Address - Fax:480-946-6077
Practice Address - Street 1:7331 E OSBORN DR STE 300
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6422
Practice Address - Country:US
Practice Address - Phone:480-946-5656
Practice Address - Fax:480-946-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty