Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 13213 | AZ |
Y | 208600000X | Surgeon | 13213 | AZ |
N | 2082S0105X | Plastic Hand Surgeon | 13213 | AZ |
NPI | 1730128695 |
---|---|
Provider Name | Burt I Faibisoff |
First Address | Lake Havasu City, AZ 86403 |
Second Address | Lake Havasu City, AZ 86403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 30/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
226672 | (05) | AZ |
C99450 | (02) |