Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35227 | AZ |
NPI | 1043268741 |
---|---|
Provider Name | Elias D. Stratigouleas |
First Address | Tucson, AZ 85712-2801 |
Second Address | Tucson, AZ 85712-2801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 12/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124771 | (05) | AZ |
I54492 | (02) | AZ |