Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD466100 | PA |
NPI | 1003475120 |
---|---|
Provider Name | Dr. Michael Bradley Avery |
First Address | Tucson, AZ 85724 |
Second Address | Tucson, AZ 85719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 10/09/2021 |