Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 29359 | AZ |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 29359 | AZ |
NPI | 1053383968 |
---|---|
Provider Name | Joel Rohrbough |
First Address | Flagstaff, AZ 86001-1176 |
Second Address | Flagstaff, AZ 86001-1398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 02/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H44118 | (02) | AZ |