Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 150128 | NY |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 57123 | AZ |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MA53823 | NJ |
NPI | 1154387637 |
---|---|
Provider Name | Dr. Edwin Raphael Guzman |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Phoenix, AZ 85013-4295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 25/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0992500 | (05) | NJ |
E81894 | (02) | NJ |