Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 20520 | AZ |
NPI | 1467480855 |
---|---|
Provider Name | Dr. Jay Grossman |
First Address | Skyland, NC 28776-2425 |
Second Address | Oro Valley, AZ 85755-6225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 03/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123662 | (05) | AZ |
B80802 | (02) | AZ |