Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 19784 | AZ |
NPI | 1043272628 |
---|---|
Provider Name | John C Opie |
First Address | Scottsdale, AZ 85255-5483 |
Second Address | Scottsdale, AZ 85255-5483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0351090 | BCBS (01) | AZ |
B32975 | (02) | |
Z125741 | MEDICARE PTAN (01) | AZ |