Organization
SEGO MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SMITH-TRYON M.D. (OWNER/MEMBER)
(928) 566-9958
Entity
Organization
Contact information
Practice address
2082 MESQUITE AVE, SUITE 106, LAKE HAVASU CITY, AZ 86403-6710
(928) 680-4233
(928) 680-6522
Mailing address
3361 HILLDALE DR, LAKE HAVASU CITY, AZ 86406-9062
(928) 566-9958
(928) 680-6522
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L-1712856-3
LLC REGISTRATION
AZ
Enumeration date
10/31/2011
Last updated
10/31/2011
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