Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 6879 | AZ |
NPI | 1033189980 |
---|---|
Provider Name | Dr. John H. Crothers |
First Address | Gilbert, AZ 85234-2168 |
Second Address | Gilbert, AZ 85234-2168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 05/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C99312 | (02) | AZ |