Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 23753 | CO |
Y | 2086S0120X | Pediatric Surgery | 32078 | AZ |
NPI | 1003808932 |
---|---|
Provider Name | Joseph S Janik |
First Address | Glendale, AZ 85306-4706 |
Second Address | Glendale, AZ 85306-4706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
539801 | (05) | AZ |
AZ0738820 | BCBS (01) | AZ |
F72729 | (02) |