Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301087727 | MI |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 45818 | AZ |
NPI | 1336342120 |
---|---|
Provider Name | Lacey A Rao |
First Address | Tucson, AZ 85710-6152 |
Second Address | Tucson, AZ 85710-6152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 05/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
703804 | (05) | AZ |
Z154980 | MEDICARE (01) | AZ |