Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 47602 | MN |
N | 207VX0000X | Obstetrician | 47602 | MN |
NPI | 1528048006 |
---|---|
Provider Name | Mark H Amols |
First Address | Mesa, AZ 85206-4676 |
Second Address | Mesa, AZ 85206-4676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 04/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
998170500 | (05) | MN |
I39595 | (02) |