Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 14446 | AZ |
NPI | 1003811001 |
---|---|
Provider Name | Candace Lew |
First Address | Gilbert, AZ 85234 |
Second Address | Tempe, AZ 85283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 31/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260216 | (05) | AZ |
D37189 | (02) | AZ |