Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 17323 | NE |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 51636 | AZ |
NPI | 1043325681 |
---|---|
Provider Name | Jeffrey T. Sugimoto |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Phoenix, AZ 85013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 25/07/2019 |