Provider Demographics
NPI:1043297690
Name:ARIZONA GASTROENTEROLOGY LTD
Entity type:Organization
Organization Name:ARIZONA GASTROENTEROLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-742-4139
Mailing Address - Street 1:7566 N LA CHOLLA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2307
Mailing Address - Country:US
Mailing Address - Phone:520-742-4139
Mailing Address - Fax:520-742-9618
Practice Address - Street 1:7566 N LA CHOLLA BLVD
Practice Address - Street 2:STE A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2307
Practice Address - Country:US
Practice Address - Phone:520-742-4139
Practice Address - Fax:520-742-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-26
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC15128Medicare ID - Type UnspecifiedRAIL ROAD
AZWCHKNMedicare PIN
AZWCHKNMedicare ID - Type UnspecifiedNORIDIAN
AZC15128Medicare PIN