Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 35194 | AZ |
NPI | 1609829506 |
---|---|
Provider Name | Jacob Amrani |
First Address | Phoenix, AZ 85027-5033 |
Second Address | Scottsdale, AZ 85255-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E72610 | (02) | AZ |