Provider Demographics
NPI:1356529820
Name:BYNUM NEAL, TARIN M (MD)
Entity type:Individual
Prefix:
First Name:TARIN
Middle Name:M
Last Name:BYNUM NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1260 S CAMPBELL RD
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2667
Mailing Address - Country:US
Mailing Address - Phone:520-407-5600
Mailing Address - Fax:520-407-5990
Practice Address - Street 1:18857 S LA CANADA DR
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-7990
Practice Address - Country:US
Practice Address - Phone:520-407-5800
Practice Address - Fax:520-407-5990
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301090314208000000X
AZ42861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ527275Medicaid
AZZ145094Medicare PIN