Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301050543 | MI |
NPI | 1003887886 |
---|---|
Provider Name | Bobby Z Joseph |
First Address | Marquette, MI 49855-2675 |
Second Address | Marquette, MI 49855-2675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030520091 | BLUE CROSS BLUE SHIELD MI (01) | MI |
2843109 | (05) | MI |
F26386 | (02) | MI |