Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 30243 | AZ |
NPI | 1427023456 |
---|---|
Provider Name | Dr. James John Bouzoukis |
First Address | Scottsdale, AZ 85260 |
Second Address | Scottsdale, AZ 85260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128392 | HEALTHNET (01) | AZ |
AZ0732540 | BLUE CROSS BLUE SHIELD (01) | AZ |
H19226 | (02) |