Basic Information
| Provider Information | |||||||||
| NPI: | 1720160245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OJO | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | CLARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 N CAMPBELL AVE | ||||||||
| Address2: | PO BOX 245030 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857240001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206266114 | ||||||||
| FaxNumber: | 5206261048 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N CAMPBELL AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857240001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206266114 | ||||||||
| FaxNumber: | 5206261048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301061704 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 4301061704 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 52023 | 01 | AZ | ARIZONA MEDICAL LICENSE | OTHER | 3293819 | 05 | MI | MEDICAID |