Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 270573 | MA |
Y | 207RI0200X | Infectious Disease | E-12096 | AR |
NPI | 1003221524 |
---|---|
Provider Name | Ian Adrian Fanoga Frani |
First Address | Hot Springs, AR 71903-1850 |
Second Address | Hot Springs, AR 71913-6442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 26/06/2019 |