Provider Demographics
NPI:1144281650
Name:TSUJIMURA, RYAN BLAINE (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:BLAINE
Last Name:TSUJIMURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15757 N 78TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1680
Mailing Address - Country:US
Mailing Address - Phone:480-787-5815
Mailing Address - Fax:480-787-5814
Practice Address - Street 1:15757 N 78TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1680
Practice Address - Country:US
Practice Address - Phone:480-787-5815
Practice Address - Fax:480-787-5814
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ231772086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0721130OtherBCBS
AZAZ0721130OtherBCBS
G98338Medicare UPIN
AZZ70671Medicare PIN