Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 4012 | AZ |
NPI | 1174551014 |
---|---|
Provider Name | James Michael Reidy |
First Address | Gilbert, AZ 85295-2152 |
Second Address | Gilbert, AZ 85295-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 28/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
876617 | (05) | AZ |
AZ0762840 | BLUE CROSS OF AZ (01) | AZ |
I17061 | (02) | AZ |