Provider Demographics
NPI:1912179391
Name:UNIVERSITY OF ARIZONA
Entity Type:Organization
Organization Name:UNIVERSITY OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ASSITANT I
Authorized Official - Prefix:DR
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:GIBSON
Authorized Official - Last Name:LAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-425-7605
Mailing Address - Street 1:PO BOX 41505
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85717-1505
Mailing Address - Country:US
Mailing Address - Phone:520-425-7605
Mailing Address - Fax:520-694-1640
Practice Address - Street 1:707 N ALVERNON WAY
Practice Address - Street 2:STE 202
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1827
Practice Address - Country:US
Practice Address - Phone:520-694-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81977282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital