Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | AZ18955 | AZ |
NPI | 1154388981 |
---|---|
Provider Name | Alex C Mclaren |
First Address | Phoenix, AZ 85012-1520 |
Second Address | Phoenix, AZ 85006-2612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 30/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102179 | AHCCCS (01) | AZ |
E79176 | (02) | AZ |