Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301075872 | MI |
N | 208600000X | Surgeon | 4301075872 | MI |
N | 208200000X | Surgeon | A 96895 | CA |
N | 208600000X | Surgeon | A 96895 | CA |
N | 208200000X | Surgeon | MD2009-0440 | NM |
N | 208600000X | Surgeon | MD2009-0440 | NM |
N | 208200000X | Surgeon | 4301075872 | MI |
N | 208600000X | Surgeon | 4301075872 | MI |
N | 208200000X | Surgeon | A 96895 | CA |
N | 208600000X | Surgeon | A 96895 | CA |
N | 208200000X | Surgeon | MD2009-0440 | NM |
N | 208600000X | Surgeon | MD2009-0440 | NM |
N | 2086S0122X | Plastic and Reconstructive Surgery | A 96895 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD2009-0440 | NM |
NPI | 1215058359 |
---|---|
Provider Name | Anil Shetty |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 22/03/2017 |