Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 7808 | AZ |
NPI | 1093722142 |
---|---|
Provider Name | Alan Lee Ansel |
First Address | Phoenix, AZ 85011 |
Second Address | Tempe, AZ 85282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
213877 | (05) | AZ |
C99062 | (02) |