Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 8592 | AZ |
N | 207ND0900X | Dermatopathologist | 8592 | AZ |
NPI | 1386684512 |
---|---|
Provider Name | Edwin P Rather |
First Address | Tucson, AZ 85710-2119 |
Second Address | Tucson, AZ 85710-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0626402 | AETNA (01) | AZ |
1Z1079 | HEALTHNET (01) | AZ |
AZ0005340 | BLUE CROSS BLUE SHIELD (01) | AZ |
D00160 | (02) | AZ |