Raul Ivan Medina Sicre, M.D.
Family Medicine in Phoenix, AZ. Individual provider (NPI-1).
NPI number1649685652
StatusActive
Last updated in NPPESJun 5, 2024
Details
- NPI
- 1649685652
- Entity type
- Individual (NPI-1)
- Name
- Raul Ivan Medina Sicre
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 27, 2014
- Certification date
- Jun 5, 2024
- Last updated
- Jun 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 58428 | AZ | Yes |
| 207Q00000X | Family Medicine | 125064345 | IL |
Practice location
1940 W Indian School Rd Ste 1Phoenix, AZ 85015-5112
Phone 602-782-1880
Mailing address
Po Box 746093Atlanta, GA 30374-6093
Phone 312-733-9730
Other practice locations
6220 W Bell Rd Ste 100
Glendale, AZ 85308-3896
Glendale, AZ 85308-3896
Phone 602-547-7300 · Fax 602-547-7301
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