Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 40180 | AZ |
NPI | 1134240146 |
---|---|
Provider Name | Gabriel Rares Colceriu |
First Address | Phoenix, AZ 85012-2369 |
Second Address | Phoenix, AZ 85012-2369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
334562 | (05) | AZ |