Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-116909 | IL |
Y | 2080P0214X | Pediatric Pulmonologist | 43248 | AZ |
NPI | 1093808370 |
---|---|
Provider Name | Dr. Leno Mammen Thomas |
First Address | Mesa, AZ 85202-4778 |
Second Address | Mesa, AZ 85202-4778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2006 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
532608 | (05) | AZ |