Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 29691 | AZ |
NPI | 1003872037 |
---|---|
Provider Name | Dr. Stephanie D Martinez Hawthorne |
First Address | Flagstaff, AZ 86001-1479 |
Second Address | Flagstaff, AZ 86001-1479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
709107 | (05) | AZ |
H67764 | (02) | AZ |