Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 28064 | AZ |
N | 207RI0011X | Interventional Cardiology | 28064 | AZ |
NPI | 1134121874 |
---|---|
Provider Name | Charles M.t. Jost |
First Address | Mesa, AZ 85206-5297 |
Second Address | Mesa, AZ 85206-5297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
492794 | (05) | AZ |
G09330 | (02) | |
G09330 | (02) | AZ |