Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 34711 | AZ |
NPI | 1023059458 |
---|---|
Provider Name | Dr. Carol Ann Ling |
First Address | Phoenix, AZ 85016-5072 |
Second Address | Phoenix, AZ 85018-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 26/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34711 | LICENSE NUMBER (01) | AZ |
H64100 | (02) |