Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301088521 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 42672 | AZ |
NPI | 1356561971 |
---|---|
Provider Name | Dr. Napoleon Recio Bravo |
First Address | Surprise, AZ 85374-3065 |
Second Address | Surprise, AZ 85374-3065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42667 | STATE LICENSE (01) | AZ |
551328 | (05) | AZ |