Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 10030 | AZ |
N | 208600000X | Surgeon | 10030 | AZ |
N | 2086S0127X | Trauma Surgeon | 23410 | AZ |
NPI | 1396704391 |
---|---|
Provider Name | Mr. Michael William Eder |
First Address | Phoenix, AZ 85068 |
Second Address | Phoenix, AZ 85020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
224303 | (05) | AZ |
C99410 | (02) |