Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 16262 | AZ |
NPI | 1003881798 |
---|---|
Provider Name | John Guisto |
First Address | Tucson, AZ 85706-7124 |
Second Address | Tucson, AZ 85724-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 30/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270851 | (05) | AZ |
930055679 | RR MEDICARE (01) | AZ |
D44003 | (02) | AZ |