Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D4537 | AZ |
NPI | 1013943612 |
---|---|
Provider Name | Joe W Abdelnour |
First Address | Bullhead City, AZ 86442 |
Second Address | Bullhead City, AZ 86442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 21/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34223B | AAHCCS (01) | AZ |
D87085 | (02) | AZ |