Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 46783 | AZ |
N | 207X00000X | Orthopaedic Surgeon | J6846 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 46783 | AZ |
NPI | 1144200106 |
---|---|
Provider Name | Jose A Alicea |
First Address | Tucson, AZ 85751-1630 |
Second Address | Tucson, AZ 85745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 14/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124214102 | (05) | TX |
779513 | (05) | AZ |
F86950 | (02) |