Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | DPM309 | AZ |
Y | 222Z00000X | Podiatrist | DPM309 | AZ |
NPI | 1053361568 |
---|---|
Provider Name | John Anthony Charski |
First Address | Scottsdale, AZ 85267-3990 |
Second Address | Scottsdale, AZ 85260-2857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
700973 | (05) | AZ |
T41484 | (02) | AZ |