Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 12409 | AZ |
NPI | 1215932322 |
---|---|
Provider Name | Lawrence James Koep |
First Address | Phoenix, AZ 85004-1401 |
Second Address | Phoenix, AZ 85004-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
230483 | (05) | AZ |
C99779 | (02) | AZ |