Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 3616 | AZ |
NPI | 1013214774 |
---|---|
Provider Name | Dr. Vern Oscar Strubeck |
First Address | Tucson, AZ 85712-6687 |
Second Address | Tucson, AZ 85712-6687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 31/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
671342 | (05) | AZ |