Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 30724 | AZ |
NPI | 1063480036 |
---|---|
Provider Name | Clarence S Adoo |
First Address | Glendale, AZ 85306-4660 |
Second Address | Glendale, AZ 85306-4660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 03/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
722604 | (05) | AZ |
G01719 | (02) |