Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25805 | AZ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 36658 | SC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 38539 | CO |
NPI | 1134119167 |
---|---|
Provider Name | John Michael Tokish |
First Address | Phoenix, AZ 85054-4502 |
Second Address | Scottsdale, AZ 85259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 10/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H25095 | (02) | CO |