Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 08354 | AZ |
NPI | 1053065003 |
---|---|
Provider Name | Jeremy Torstveit |
First Address | Phoenix, AZ 85003-1104 |
Second Address | Phoenix, AZ 85006-2609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2022 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD08356 | MD08354 (01) | AZ |