Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 235662 | NY |
Y | 207P00000X | Emergency Physician | 47189 | AZ |
NPI | 1013000751 |
---|---|
Provider Name | Dr. Jose Carbajal |
First Address | Tucson, AZ 85711-1896 |
Second Address | Tucson, AZ 85711-2602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 13/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I44684 | (02) | NY |