Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 32467 | AZ |
NPI | 1003898388 |
---|---|
Provider Name | David L Massanari |
First Address | Tucson, AZ 85712-6687 |
Second Address | Tucson, AZ 85712-6687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 30/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
845191 | (05) | AZ |
B86869 | (02) | AZ |