Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 54040 | AZ |
NPI | 1003211095 |
---|---|
Provider Name | Dr. Fnu Pardeep |
First Address | Yuma, AZ 85364-6123 |
Second Address | San Luis, AZ 85349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2014 |
Last Update Date | 15/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279557 | (05) | AZ |