Provider Demographics
NPI:1932308970
Name:VICARY, CHRISTINE M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:VICARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:630 N ALVERNON WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1843
Mailing Address - Country:US
Mailing Address - Phone:520-647-8854
Mailing Address - Fax:520-647-8851
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-647-8854
Practice Address - Fax:520-647-8851
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2015-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ81905207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ517268Medicaid
AZ517268Medicaid