Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 53545 | AZ |
Y | 208600000X | Surgeon | 53545 | AZ |
N | 2086S0102X | Surgical Critical Care | 53545 | AZ |
NPI | 1255312534 |
---|---|
Provider Name | John D Kizer |
First Address | Mesa, AZ 85202-4742 |
Second Address | Mesa, AZ 85202-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 05/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
246831 | (05) | AZ |
E77822 | (02) |