Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | C5910 | AR |
NPI | 1003881749 |
---|---|
Provider Name | John Paul Brizzolara |
First Address | Little Rock, AR 72211-4349 |
Second Address | Little Rock, AR 72211-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 05/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B90008 | (02) |