Provider Demographics
NPI:1700067014
Name:RYAN TSUJIMURA MDPC
Entity Type:Organization
Organization Name:RYAN TSUJIMURA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUJIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-353-2956
Mailing Address - Street 1:108 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5818
Mailing Address - Country:US
Mailing Address - Phone:480-649-3774
Mailing Address - Fax:480-649-3685
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:# 257
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-353-2956
Practice Address - Fax:480-353-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ231772086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ70672Medicare PIN