Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 17526 | AZ |
NPI | 1326151028 |
---|---|
Provider Name | Dr. Samson Gary Serbin |
First Address | Phoenix, AZ 85015-2110 |
Second Address | Phoenix, AZ 85015-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122502 | HEALTHNET (01) | AZ |
299124-01 | (05) | AZ |
3354946 | CIGNA (01) | AZ |
4062898 | AETNA (01) | AZ |
AZ0258960 | BLUE CROSS (01) | AZ |
C46701 | (02) | AZ |