# MEDIFAST TUCSON COM INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bard T. Manny, MD.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073970133
- **Authorized official:** BRAD T MANNY MD (PRESIDENT)
- **Authorized official phone:** (520) 733-2250

## Contact information

- **Practice address:** 5350 E ERICKSON DR, TUCSON, AZ 85712-2822
- **Practice address phone:** (520) 733-2250
- **Practice address fax:** (520) 733-2270
- **Mailing address:** PO BOX 14377, TUCSON, AZ 85732-4377
- **Mailing address phone:** (520) 733-2250
- **Mailing address fax:** (520) 733-2270

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/20/2016
- **Last updated:** 01/21/2016