Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 6786 | AZ |
NPI | 1043567613 |
---|---|
Provider Name | Dr. Alexander B. White |
First Address | Scottsdale, AZ 85255-4532 |
Second Address | Scottsdale, AZ 85255-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2012 |
Last Update Date | 13/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6786 | AZ MEDICAL LICENSE (01) | AZ |