Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 150 | AZ |
Y | 222Z00000X | Podiatrist | 150 | AZ |
NPI | 1003808692 |
---|---|
Provider Name | Dr. Martin Barry Rosenthal |
First Address | Tucson, AZ 85750-0970 |
Second Address | Tucson, AZ 85710-2117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 21/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
700593 03 | (05) | AZ |
AZ0191700 | BCBS INSURANCE (01) | AZ |
T42086 | (02) | AZ |