Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53293 | AZ |
N | 208000000X | Pediatrician | MD066496L | PA |
Y | 2080P0210X | Pediatric Nephrologist | 53293 | AZ |
N | 2080P0210X | Pediatric Nephrologist | MD066496L | PA |
NPI | 1720054323 |
---|---|
Provider Name | Dr. Abhay N Vats |
First Address | Phoenix, AZ 85054-3117 |
Second Address | Glendale, AZ 85308-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001754256 | (05) | PA |
235567 | (05) | AZ |
F75272 | (02) | PA |