Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 353 | NM |
Y | 213ES0103X | Foot & Ankle Surgery | 875 | AZ |
NPI | 1063728905 |
---|---|
Provider Name | Chad Allen Squire |
First Address | Snowflake, AZ 85937-5585 |
Second Address | Snowflake, AZ 85937-5585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2010 |
Last Update Date | 07/02/2022 |