Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0154 | AZ |
Y | 222Z00000X | Podiatrist | 0154 | AZ |
NPI | 1063401941 |
---|---|
Provider Name | Dr. Michael H Dershowitz |
First Address | Phoenix, AZ 85006-2503 |
Second Address | Phoenix, AZ 85006-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 21/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T41547 | (02) | AZ |