Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | LT000771 | PA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | LT000771 | PA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MT213590 | PA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | TL166 | AZ |
NPI | 1780125906 |
---|---|
Provider Name | Dr. Javier Ignacio Gentile |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2017 |
Last Update Date | 18/12/2018 |