Basic Information
| Provider Information | |||||||||
| NPI: | 1952569600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOOFAN | ||||||||
| FirstName: | MARC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 N 12TH ST STE 301 | ||||||||
| Address2: | EPS | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028396968 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 N 12TH ST STE 301 | ||||||||
| Address2: | EPS | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028396968 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 11/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | N1479 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 49734 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.