Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 81890 | AZ |
NPI | 1013188234 |
---|---|
Provider Name | Dr. Ajit Itty |
First Address | Tucson, AZ 85716-1072 |
Second Address | Tucson, AZ 85724-1006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2008 |
Last Update Date | 14/03/2008 |