Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 43146 | AZ |
Y | 207VX0201X | Gynecologic Oncologist | 43146 | AZ |
NPI | 1487734646 |
---|---|
Provider Name | Bradley J Monk |
First Address | Tucson, AZ 85718-5877 |
Second Address | Phoenix, AZ 85016-4872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 07/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
522627 | (05) | AZ |