Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 24106 | AZ |
NPI | 1154379642 |
---|---|
Provider Name | Donald Charles Sheridan |
First Address | Scottsdale, AZ 85258-4561 |
Second Address | Scottsdale, AZ 85258-4561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 14/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00514071 | INTERGROUP (01) | AZ |
200034022 | RAILROAD MEDICARE (01) | |
2032674 | AETNA (01) | AZ |
24479 | MEDICARE PTAN (01) | AZ |
34408604 | AHCCCS (01) | AZ |
AZ0831310 | BLUE CROSS BLUE SHIELD (01) | AZ |
F31292 | (02) |