Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 31231 | AZ |
N | 207QS0010X | Family Doctor - Sports Medicine | 31231 | AZ |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 31231 | AZ |
NPI | 1033166012 |
---|---|
Provider Name | Heather Elwood |
First Address | Phoenix, AZ 85027-4171 |
Second Address | Phoenix, AZ 85032-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H26873 | (02) |