Active NPI
Andrew Fombang, MD
- Psychiatry Physician
- Tucson, AZ
National Provider Identifier
1104755909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- R82700
- Practice address
- 2800 E Ajo Way
Tucson, AZ 85713-6204 - Phone
- (520) 874-6648
- Fax
- (520) 874-7539
- NPI assigned
- May 18, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | R82700 | AZ | Primary |
Addresses
Primary practice location
2800 E Ajo Way
Tucson, AZ 85713-6204
Mailing address
2800 E Ajo Way
Tucson, AZ 85713-6204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R82700 | AZ | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779062400000",
"number": "1104755909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 E AJO WAY",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857136204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 E AJO WAY",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857136204",
"telephone_number": "520-874-6648",
"fax_number": "520-874-7539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMBANG",
"first_name": "ANDREW",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-05-18",
"last_updated": "2026-05-18",
"certification_date": "2026-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AZ",
"license": "R82700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.