Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 35047 | AZ |
NPI | 1023087301 |
---|---|
Provider Name | John I Iskandar |
First Address | Mesa, AZ 85210-6889 |
Second Address | Mesa, AZ 85210-6889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 13/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053237 | (05) | AZ |
H66664 | (02) |