Tillman, Laura
Tillman, Laura is an individual health care provider with primary practice located at 4212 North 16Th Street Department Of Surgery, Phoenix AZ 85016. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Tillman, Laura can be contacted via phone (602) 263-1511.Contact Information
Primary practice address
4212 North 16Th Street Department Of Surgery
Phoenix AZ 85016
Phone: (602) 263-1511
Fax: (602) 263-1637
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 24835 | Arizona |
Profile Details
| NPI number | 1932295748 |
|---|---|
| LBN Legal business name | Tillman, Laura |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 5th, 2006 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932295748 | NPPES |
| Arizona | MEDICAID | 483537 | |
| Arizona | Other | AZ0722860 |
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