Provider Demographics
NPI:1548483571
Name:YUMA EAR, NOSE AND THROAT, LTD
Entity type:Organization
Organization Name:YUMA EAR, NOSE AND THROAT, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:KABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-919-3510
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2313
Mailing Address - Country:US
Mailing Address - Phone:928-920-4772
Mailing Address - Fax:
Practice Address - Street 1:2320 S 22ND DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8867
Practice Address - Country:US
Practice Address - Phone:928-920-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20676Medicare UPIN
AZDOOO91Medicare UPIN
AZF84540Medicare UPIN
AZG46993Medicare UPIN