Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 49481 | AZ |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 49481 | AZ |
NPI | 1821275231 |
---|---|
Provider Name | George T Gendy |
First Address | Glendale, AZ 85308-1372 |
Second Address | Phoenix, AZ 85027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 19/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | AZ |