Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 008452 | AZ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 008452 | AZ |
NPI | 1245539659 |
---|---|
Provider Name | Dr. Ambrose Francis Panico |
First Address | Mesa, AZ 85206-6103 |
Second Address | Mesa, AZ 85206-6103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 05/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007236 | (05) | AZ |