Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 000348 | AZ |
Y | 213ES0000X | Sports Medicine | 000348 | AZ |
NPI | 1457910416 |
---|---|
Provider Name | George Hackett |
First Address | Phoenix, AZ 85017-1097 |
Second Address | Phoenix, AZ 85017-1097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 12/06/2019 |