Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 29410 | AZ |
NPI | 1689635989 |
---|---|
Provider Name | Dr. Gregory M Hrasky |
First Address | Scottsdale, AZ 85252-2767 |
Second Address | Mesa, AZ 85202-4713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 25/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29410 | LICENSE (01) | AZ |
597354 | (05) | AZ |
861037317 | TAX ID (01) | AZ |
BH5027102 | DEA (01) | AZ |
G30464 | (02) | AZ |