Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 005038 | AZ |
N | 207L00000X | Anesthesiologist | 036082979 | IL |
NPI | 1003905183 |
---|---|
Provider Name | Dr. Eric L Pedicini |
First Address | Phoenix, AZ 85004-4527 |
Second Address | Phoenix, AZ 85004-4527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 22/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
408868 | (05) | AZ |
F13515 | (02) | |
P00862630 | MEDICARE RAILROAD (01) |