Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 20808 | AZ |
NPI | 1255390936 |
---|---|
Provider Name | Jordan H. Perlow |
First Address | Phoenix, AZ 85006-2727 |
Second Address | Phoenix, AZ 85006-2727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 31/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112475 | (05) | AZ |
E69455 | (02) | AZ |
U3715 | (05) | NM |