Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 036-076916 | IL |
NPI | 1174631196 |
---|---|
Provider Name | Dr. Bruce M Hecht |
First Address | Phoenix, AZ 85006-1464 |
Second Address | Phoenix, AZ 85006-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 23/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-076-916 | (05) | IL |
D13548 | (02) |