Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | E4141 | AR |
NPI | 1093772055 |
---|---|
Provider Name | Dr. Michael Charles Carozza |
First Address | Arkadelphia, AR 71923-4228 |
Second Address | Arkadelphia, AR 71923-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 16/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179159001 | (05) | AR |
771102401 | BREASTCARE (01) | AR |