Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 27986 | AZ |
NPI | 1518930627 |
---|---|
Provider Name | Mr. Sean Patrick Elliott |
First Address | Tucson, AZ 85751-1235 |
Second Address | Tucson, AZ 85712-4416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
491027 | (05) | AZ |
H07933 | (02) | AZ |