| Tatum Ridge Internal Medicine Plc | |
|
18404 N Tatum Blvd Ste 205 Phoenix AZ 85032-1509 | |
| (602) 971-5500 | |
| (602) 944-0504 |
| Full Name | Tatum Ridge Internal Medicine Plc |
|---|---|
| Speciality | Internal Medicine |
| Location | 18404 N Tatum Blvd, Phoenix, Arizona |
| Authorized Official Name and Position | David Lawrence Elliot (PHYSICIAN PARTNER) |
| Authorized Official Contact | 6029715500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tatum Ridge Internal Medicine Plc 18404 N Tatum Blvd Ste 205 Phoenix AZ 85032-1509 Ph: (602) 971-5500 | Tatum Ridge Internal Medicine Plc 18404 N Tatum Blvd Ste 205 Phoenix AZ 85032-1509 Ph: (602) 971-5500 |
| NPI Number | 1083622997 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 03/30/2011 |
| Medicare PECOS PAC ID | 6901890821 |
|---|---|
| Medicare Enrollment ID | O20040413001423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083622997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Chi Q Duong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285642108 PECOS PAC ID: 4587658307 Enrollment ID: I20091021000534 |
| Provider Name | Brian K Jorgensen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730197658 PECOS PAC ID: 9234123050 Enrollment ID: I20100325000182 |
| Provider Name | David L Elliott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194733006 PECOS PAC ID: 0244224061 Enrollment ID: I20100325000625 |
| Provider Name | Lawrence P Gassner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558379461 PECOS PAC ID: 4688668403 Enrollment ID: I20100325000647 |
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