Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 036100171 | IL |
Y | 207YP0228X | Pediatric Otolaryngology | 58195 | AZ |
NPI | 1487765319 |
---|---|
Provider Name | Mark Evan Gerber |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
499847 | (05) | AZ |
G79244 | (02) |