Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 12593 | AZ |
NPI | 1003881806 |
---|---|
Provider Name | Asha Thakur |
First Address | Phoenix, AZ 85069-9179 |
Second Address | Phoenix, AZ 85021-5472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 21/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212936 | (05) | AZ |
D37742 | (02) |