Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | M3731 | ID |
NPI | 1396816096 |
---|---|
Provider Name | Frederick P Ambrose |
First Address | Coeur D Alene, ID 83814-2668 |
Second Address | Coeur D Alene, ID 83814-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D93681 | (02) |