Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 016005677 | IL |
N | 222Z00000X | Podiatrist | 016005677 | IL |
N | 213E00000X | Podiatrist | 0836 | AZ |
N | 222Z00000X | Podiatrist | 0836 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | 016005677 | IL |
Y | 213ES0103X | Foot & Ankle Surgery | POD000836 | AZ |
NPI | 1073872859 |
---|---|
Provider Name | Dr. Keith Arbuckle |
First Address | Glendale, AZ 85308-6045 |
Second Address | Sun City West, AZ 85375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2012 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016005677 | (05) | IL |
161742 | (05) | AZ |