Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 55831 | AZ |
Y | 208600000X | Surgeon | 55831 | AZ |
NPI | 1003252453 |
---|---|
Provider Name | Cole Mcewen |
First Address | Phoenix, AZ 85004-1303 |
Second Address | Phoenix, AZ 85037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
379921 | (05) | AZ |