Individual
TARA MARIA OSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
20040 N 19TH AVE, SUITE A, PHOENIX, AZ 85027-4255
(623) 869-5000
(623) 869-0927
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(623) 869-5000
(623) 869-0927
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26889
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
565492
—
AZ
Enumeration date
10/13/2005
Last updated
01/27/2017
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