Provider Demographics
NPI:1720160245
Name:OJO, TAMMY CLARK (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:CLARK
Last Name:OJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:PO BOX 245030
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-626-6114
Mailing Address - Fax:520-626-1048
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-626-6114
Practice Address - Fax:520-626-1048
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061704207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ52023OtherARIZONA MEDICAL LICENSE
MI3293819Medicaid
AZ52023OtherARIZONA MEDICAL LICENSE
MI3293819Medicaid