Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 34060 | AZ |
NPI | 1003890872 |
---|---|
Provider Name | Diana M Bui |
First Address | Phoenix, AZ 85054-4502 |
Second Address | Phoenix, AZ 85054-4502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86080015085259D012 | TRIWEST (01) | AZ |
945280 | (05) | AZ |
H91821 | (02) | |
P00229610 | RR MEDICARE (01) | AZ |