Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 25446 | AZ |
NPI | 1740242320 |
---|---|
Provider Name | Mark W Joseph |
First Address | Phoenix, AZ 85018-2322 |
Second Address | Phoenix, AZ 85016-7941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 03/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
395245 | (05) | AZ |
G64278 | (02) |