Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101248481 | VA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 0101248481 | VA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 46045 | AZ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101248481 | VA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 0101248481 | VA |
NPI | 1437117835 |
---|---|
Provider Name | Edward P Fink |
First Address | Glendale, AZ 85306-4706 |
Second Address | Glendale, AZ 85306-4706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
683132 | (05) | AZ |