Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 31470 | AZ |
NPI | 1013913656 |
---|---|
Provider Name | Dr. Zia Mansoor |
First Address | Phoenix, AZ 85038-9211 |
Second Address | Phoenix, AZ 85008-4503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 05/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H87749 | (02) | AZ |