Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 005503 | AZ |
Y | 213ES0000X | Sports Medicine | 005503 | AZ |
NPI | 1366622466 |
---|---|
Provider Name | Dr. Jonathan David Tait |
First Address | Oro Valley, AZ 85704-6589 |
Second Address | Oro Valley, AZ 85704-6589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2007 |
Last Update Date | 28/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z145821 | (02) | AZ |