Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 260 | AZ |
NPI | 1083674857 |
---|---|
Provider Name | Dr. Raymond R Botte |
First Address | Phoenix, AZ 85050-2501 |
Second Address | Phoenix, AZ 85032-2122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 16/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
172453 | (05) | AZ |
T78843 | (02) | AZ |