Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 22346 | AZ |
NPI | 1053308098 |
---|---|
Provider Name | John David Macias |
First Address | Phoenix, AZ 85006-2523 |
Second Address | Phoenix, AZ 85006-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 09/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F64798 | (02) |