Provider Demographics
NPI:1831391127
Name:SOUTHWESTERN PHYSICIANS PC
Entity type:Organization
Organization Name:SOUTHWESTERN PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-885-2231
Mailing Address - Street 1:PO BOX 17689
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-7689
Mailing Address - Country:US
Mailing Address - Phone:520-885-2231
Mailing Address - Fax:520-885-2471
Practice Address - Street 1:6743 E CAMINO PRINCIPAL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3905
Practice Address - Country:US
Practice Address - Phone:520-885-2231
Practice Address - Fax:520-885-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13085207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ617524Medicaid
AZCJ3664OtherMEDICARE RAILROAD
AZZ157407Medicare PIN