Provider Demographics
NPI:1295713543
Name:STRUSE, T BRYSON (DO)
Entity type:Individual
Prefix:DR
First Name:T
Middle Name:BRYSON
Last Name:STRUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:4892 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5761
Practice Address - Country:US
Practice Address - Phone:520-696-4780
Practice Address - Fax:520-293-7024
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0873207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z3434OtherHEALTH NET OF AZ
AZAZ0045850OtherBCBSAZ
AZ224436Medicaid
AZZ20456Medicare PIN
AZZ20457Medicare PIN
AZ1Z3434OtherHEALTH NET OF AZ
E20693Medicare UPIN
AZ224436Medicaid
AZZ20458Medicare PIN