Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 47439 | AZ |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 47439 | AZ |
NPI | 1033386669 |
---|---|
Provider Name | Tracey Newlove |
First Address | Tucson, AZ 85710-2157 |
Second Address | Tucson, AZ 85710-2157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 01/04/2016 |