Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 20534 | AZ |
Y | 208600000X | Surgeon | 20534 | AZ |
NPI | 1013985191 |
---|---|
Provider Name | Daniel E Wesche |
First Address | Scottsdale, AZ 85271-0577 |
Second Address | Flagstaff, AZ 86001-1479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 25/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
312918 | (05) | AZ |
AZ0825790 | BLUE CROSS BLUE SHIELD AZ (01) | AZ |
G06892 | (02) |