Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 13653 | AZ |
NPI | 1063482024 |
---|---|
Provider Name | Dr. Gordon E Chait |
First Address | Phoenix, AZ 85004-1206 |
Second Address | Glendale, AZ 85306-4660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
245987 | (05) | AZ |
799702 | (05) | AZ |
AZ0852270 | BC/BS PROVIDER ID (01) | AZ |
D36658 | (02) | |
MD980AZ | (05) | AL |