Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 5317 | AZ |
NPI | 1013929215 |
---|---|
Provider Name | Gordon A Ewy |
First Address | Tucson, AZ 85706-7124 |
Second Address | Tucson, AZ 85724-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060020937 | RR MEDICARE (01) | AZ |
237687 | (05) | AZ |
C99441 | (02) |