Provider Demographics
NPI:1265723175
Name:FOGELSON, DAVID MARTIN (CCT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARTIN
Last Name:FOGELSON
Suffix:
Gender:M
Credentials:CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28666
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0161
Mailing Address - Country:US
Mailing Address - Phone:480-262-1621
Mailing Address - Fax:602-792-9133
Practice Address - Street 1:5240 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3630
Practice Address - Country:US
Practice Address - Phone:480-262-1621
Practice Address - Fax:602-792-9133
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies