Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 22280 | AZ |
N | 208600000X | Surgeon | 22280 | AZ |
Y | 2086S0127X | Trauma Surgeon | 22280 | AZ |
NPI | 1407944416 |
---|---|
Provider Name | Eric Davis Kendle |
First Address | Flagstaff, AZ 86001-1479 |
Second Address | Flagstaff, AZ 86001-1479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 23/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350687 | (05) | AZ |
G26692 | (02) |