Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 48796 | AZ |
NPI | 1174941108 |
---|---|
Provider Name | Dr. Pankaj Jain |
First Address | Mesa, AZ 85202-4707 |
Second Address | Mesa, AZ 85202-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 07/04/2014 |