Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 30266 | AZ |
NPI | 1548251135 |
---|---|
Provider Name | Gerald A Mandell |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 18/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1197546 | (05) | PA |
5166900 | (05) | NJ |
689432 | (05) | AZ |
7703716 | (05) | MD |
91013900 | (05) | FL |
C48582 | (02) |