Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 21585 | AZ |
NPI | 1447229802 |
---|---|
Provider Name | Alton Venson Hallum |
First Address | Tucson, AZ 85718-5999 |
Second Address | Tucson, AZ 85704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 18/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140426 | (05) | AZ |
E96170 | (02) | AZ |