Provider Demographics
NPI:1295100816
Name:MARTY GILES, MD, P.C.
Entity type:Organization
Organization Name:MARTY GILES, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-547-2311
Mailing Address - Street 1:7395 E TANQUE VERDE RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7395 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3475
Practice Address - Country:US
Practice Address - Phone:520-547-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ29041Medicaid
AZ327735Medicare UPIN