Breast Center of Southern Arizona LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

32120 Issued in AZ

Legal business name

BREAST CENTER OF SOUTHERN ARIZONA LLC

Practice address

5230 E Farness Dr
Suite 104
Tucson, AZ 85712-2141

Phone

(520) 319-6686

Fax

(520) 319-6696

NPI assigned

Sep 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eric B Whitacre, MD

Title

President

Phone

(520) 319-6686

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467552273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43130",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857333130",
            "telephone_number": "520-722-3777",
            "fax_number": "520-296-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5230 E FARNESS DR",
            "address_2": "SUITE 104",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122141",
            "telephone_number": "520-319-6686",
            "fax_number": "520-319-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAST CENTER OF SOUTHERN ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITACRE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-319-6686",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "AZ",
            "license": "32120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "829426",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.