Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 21322 | AZ |
NPI | 1023054780 |
---|---|
Provider Name | Mr. John M Ruboyianes |
First Address | Tucson, AZ 85719 |
Second Address | Tucson, AZ 85719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132621 | AZ BILLING IDENTIFIER (01) | |
F18639 | (02) |