Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 449 | AZ |
Y | 222Z00000X | Podiatrist | 449 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | DPM 449 | AZ |
N | 213ES0131X | Foot Surgery | 449 | AZ |
NPI | 1053344929 |
---|---|
Provider Name | Dr. Edward William Tierney |
First Address | Chandler, AZ 85248 |
Second Address | Chandler, AZ 85248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U62290 | (02) | AZ |