Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 19302 | AZ |
NPI | 1013984970 |
---|---|
Provider Name | Dr. Thimmavajjhala Sreecharana |
First Address | Peoria, AZ 85385-5336 |
Second Address | Peoria, AZ 85381-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 15/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171182 | (05) | AZ |
E86245 | (02) | AZ |