Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | APPLIED FOR | AZ |
Y | 2086S0127X | Trauma Surgeon | APPLIED FOR | AZ |
NPI | 1205095817 |
---|---|
Provider Name | Dr. Andrews C Ninan |
First Address | Bowling Green, KY 42104-0823 |
Second Address | Phoenix, AZ 85008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 09/06/2008 |