Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 53543 | AZ |
NPI | 1295716926 |
---|---|
Provider Name | Dr. Diego John Muilenburg |
First Address | Goodyear, AZ 85338-3007 |
Second Address | Goodyear, AZ 85338-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |