Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 24993 | AZ |
NPI | 1194816702 |
---|---|
Provider Name | Brad Golner |
First Address | Phoenix, AZ 85050-3362 |
Second Address | Phoenix, AZ 85050-3362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 19/10/2011 |