Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 27696 | AZ |
NPI | 1053305540 |
---|---|
Provider Name | Melissa M Go |
First Address | Tempe, AZ 85284-3494 |
Second Address | Phoenix, AZ 85004-1580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 19/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
476954 | (05) | AZ |
H11481 | (02) |