Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 28552 | AZ |
N | 207U00000X | Nuclear Medicine Specialist | 28552 | AZ |
NPI | 1588637326 |
---|---|
Provider Name | Edgar Arthur Suter |
First Address | Tempe, AZ 85282-6757 |
Second Address | San Tan Valley, AZ 85143-5096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 05/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1588637326 | MEDICARE-NPI (01) | AZ |
945454 | (05) | AZ |
A48884 | (02) |