Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | R70375 | AZ |
NPI | 1144450131 |
---|---|
Provider Name | Dr. Jeremy Clyde Racey |
First Address | Tucson, AZ 85741-2307 |
Second Address | Tucson, AZ 85741-3529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 11/01/2011 |