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Individual

RAUL IVAN MEDINA SICRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1940 W INDIAN SCHOOL RD STE 1, PHOENIX, AZ 85015-5112
(602) 782-1880
Mailing address
PO BOX 746093, ATLANTA, GA 30374-6093
(312) 733-9730

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125064345
IL
207Q00000X
Family Medicine Physician
Primary
58428
AZ

Other

Enumeration date
06/27/2014
Last updated
06/05/2024
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