Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | AZ #12127 | AZ |
N | 207Q00000X | Family Doctor | MN#24356 | MN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | AZ #12127 | AZ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MN#24356 | MN |
NPI | 1063508463 |
---|---|
Provider Name | Dr. Eric M Ossowski |
First Address | Pasadena, CA 91110-0698 |
Second Address | Phoenix, AZ 85016-5319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 26/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
414160 | (05) | AZ |
AZ0713230 | BCBS (01) | AZ |
H45190 | (02) | AZ |