Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 48945 | AZ |
NPI | 1053631457 |
---|---|
Provider Name | Ali M Rkein |
First Address | Gilbert, AZ 85295-6220 |
Second Address | Gilbert, AZ 85295-6220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 24/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45945 | (05) | AZ |