Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 43688 | AZ |
Y | 208600000X | Surgeon | 43688 | AZ |
N | 208200000X | Surgeon | A81670 | CA |
N | 208600000X | Surgeon | A81670 | CA |
N | 2086X0206X | Surgical Oncologist | 43688 | AZ |
NPI | 1427078708 |
---|---|
Provider Name | Lora Hebert |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Phoenix, AZ 85004-2155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 18/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43688 | (02) | AZ |
H77785 | (02) | CA |