Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | AP10262 | AZ |
NPI | 1184153900 |
---|---|
Provider Name | Elya M Showalter |
First Address | Yuma, AZ 85364-6123 |
Second Address | Yuma, AZ 85364-6123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 09/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
272661 | (05) | AZ |