Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 23053 | AZ |
NPI | 1053491316 |
---|---|
Provider Name | Anthony Nagorka |
First Address | Phoenix, AZ 85014-1101 |
Second Address | Phoenix, AZ 85014-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 04/11/2011 |