Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25976 | AZ |
N | 207ND0101X | MOHS-Micrographic Surgeon | 25976 | AZ |
N | 207ND0900X | Dermatopathologist | 25976 | AZ |
N | 207NS0135X | Procedural Dermatology | 25976 | AZ |
NPI | 1386647865 |
---|---|
Provider Name | Michael J. Huether |
First Address | Tucson, AZ 85740-7075 |
Second Address | Tucson, AZ 85741-3535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 30/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
426272002 | (05) | AZ |
G65433 | (02) | AZ |