Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 12438 | AZ |
NPI | 1922076090 |
---|---|
Provider Name | Mr. Sebastian B Ruggeri |
First Address | Phoenix, AZ 85016 |
Second Address | Phoenix, AZ 85016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 11/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
229254 | (05) | AZ |
E00176 | (02) |