Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 32803 | AZ |
NPI | 1003808809 |
---|---|
Provider Name | Mr. Sharam Danesh |
First Address | Phoenix, AZ 85050-3388 |
Second Address | Phoenix, AZ 85050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 20/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H25809 | (02) | AZ |
P00179455 | RAILROAD MEDICARE (01) | AZ |