Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 22666 | AZ |
Y | 208600000X | Surgeon | 22666 | AZ |
NPI | 1013952464 |
---|---|
Provider Name | James C Balserak |
First Address | Tucson, AZ 85712-8000 |
Second Address | Tucson, AZ 85712-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 05/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F96288 | (02) | AZ |