Provider Demographics
NPI:1861654196
Name:ANTONIO T UVAS PLLC
Entity Type:Organization
Organization Name:ANTONIO T UVAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:T
Authorized Official - Last Name:UVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-776-3047
Mailing Address - Street 1:14300 W. GRANITE VALLEY DRIVE STE B-7
Mailing Address - Street 2:UVAS FAMILY MEDICINE
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:623-776-3047
Mailing Address - Fax:623-776-3127
Practice Address - Street 1:14300 W. GRANITE VALLEY DR SUITE B-7
Practice Address - Street 2:UVAS FAMILY MEDICINE
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:623-776-3047
Practice Address - Fax:623-776-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119181Medicaid
AZ119181Medicaid