Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 17412 | NV |
NPI | 1083870554 |
---|---|
Provider Name | Dr. Saju Joseph |
First Address | Las Vegas, NV 89128-9009 |
Second Address | Las Vegas, NV 89118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 15/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1308005 | (05) | LA |