Organization
ERIK DE JONGHE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN FREDERIKSEN MD (PRACTICE ADMINISTRATOR)
(520) 615-0318
Entity
Organization
Contact information
Practice address
1601 W ST MARYS RD, TUCSON, AZ 85745
(520) 872-7383
(520) 872-7969
Mailing address
2202 N FORBES BLVD, TUCSON, AZ 85745-1412
(520) 872-7383
(520) 872-7969
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
31026
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805228
—
AZ
Enumeration date
06/08/2007
Last updated
07/21/2008
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