Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 221018 | AZ |
NPI | 1326512203 |
---|---|
Provider Name | Mr. Scott Tomlinson |
First Address | Phoenix, AZ 85020-4730 |
Second Address | Phoenix, AZ 85006-2612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2019 |
Last Update Date | 14/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
221018 | ARIZONA STATE BOARD OF NURSING (01) | AZ |