Provider Demographics
NPI:1669901211
Name:WU, PATRICIA IOANNA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:IOANNA
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-2413
Mailing Address - Country:US
Mailing Address - Phone:520-364-1120
Mailing Address - Fax:
Practice Address - Street 1:1906 E 11TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2413
Practice Address - Country:US
Practice Address - Phone:520-364-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR76361207Q00000X
AZ61127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine