Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | M-8137 | ID |
Y | 208600000X | Surgeon | M-8137 | ID |
N | 208200000X | Surgeon | M8137 | ID |
N | 208600000X | Surgeon | M8137 | ID |
NPI | 1003869629 |
---|---|
Provider Name | Aziz George Munayirji |
First Address | Meridian, ID 83642-1026 |
Second Address | Boise, ID 83706-1334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 17/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
805941500 | (05) | ID |
F35457 | (02) |