Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 33323 | AZ |
N | 2080P0210X | Pediatric Nephrologist | 33323 | AZ |
NPI | 1497753750 |
---|---|
Provider Name | Dr. Rajeev Agarwal |
First Address | Phoenix, AZ 85054-3117 |
Second Address | Phoenix, AZ 85054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
927204 | (05) | AZ |
H04042 | (02) |