Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 287749 | MA |
NPI | 1083024954 |
---|---|
Provider Name | Anthony Guzman |
First Address | Jamaica Plain, MA 02130-3446 |
Second Address | Jamaica Plain, MA 02130-3446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2014 |
Last Update Date | 14/01/2022 |