Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 27262 | AZ |
NPI | 1699743294 |
---|---|
Provider Name | Mrs. Mary Elizabeth Landau-Levine |
First Address | Scottsdale, AZ 85260-3696 |
Second Address | Scottsdale, AZ 85260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 27/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
495467 | (05) | AZ |
H11279 | (02) |