Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 019973E | PA |
NPI | 1477510238 |
---|---|
Provider Name | Murtaza E. Nurbhai |
First Address | Coudersport, PA 16915-8161 |
Second Address | Coudersport, PA 16915-8161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005873040002 | (05) | PA |
063776 | HIGHMARK BLUE SHIELD (01) | PA |
B34685 | (02) | PA |