Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 20398 | AZ |
N | 207R00000X | Internist | 20398 | AZ |
N | 111NI0900X | Internist | 20398 | AZ |
NPI | 1003860842 |
---|---|
Provider Name | Mark Chorebanian |
First Address | Tucson, AZ 85716-1165 |
Second Address | Lake Havasu City, AZ 86403-5607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F29303 | (02) | AZ |