Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036121140 | IL |
N | 111NI0900X | Internist | 036121140 | IL |
Y | 207RC0200X | Critical Care Medicine | 57295 | AZ |
N | 207RP1001X | Pulmonary Disease | 57295 | AZ |
N | 207RS0012X | Sleep Medicine | 57295 | AZ |
NPI | 1114103892 |
---|---|
Provider Name | Dr. Hristo Deianov Hristov |
First Address | Phoenix, AZ 85020-2463 |
Second Address | Phoenix, AZ 85020-2463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2008 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
449743 | (05) | AZ |