Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 34690 | AZ |
N | 111NI0900X | Internist | 34690 | AZ |
Y | 207RI0200X | Infectious Disease | 34690 | AZ |
NPI | 1093769689 |
---|---|
Provider Name | Dr. Vipul Ganatra |
First Address | Chandler, AZ 85248-0013 |
Second Address | Phoenix, AZ 85013-4409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104773-01 | (05) | AZ |
BG9691519 | DEA NUMBER (01) | AZ |