Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 0145 | AZ |
NPI | 1568592459 |
---|---|
Provider Name | Murray Susser |
First Address | Scottsdale, AZ 85260-6411 |
Second Address | Scottsdale, AZ 85260-6411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90759 | (02) | CA |