Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 11239 | AZ |
NPI | 1558443465 |
---|---|
Provider Name | Dr. Glen Henry Strohm |
First Address | Tucson, AZ 85745 |
Second Address | Tucson, AZ 85745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
236100 | (05) | AZ |
E00196 | (02) | AZ |