Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 19589 | AZ |
Y | 207RR0500X | Rheumatology | 19589 | AZ |
NPI | 1366415036 |
---|---|
Provider Name | Kenneth A Epstein |
First Address | Flagstaff, AZ 86001-7218 |
Second Address | Flagstaff, AZ 86001-7218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 25/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
296964 | (05) | AZ |
E77524 | (02) |