Individual
TARA MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016
(602) 933-0970
(602) 933-4253
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1813
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
76554
GA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
006652
AZ
Other
Enumeration date
05/24/2010
Last updated
09/06/2018
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