Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0745 | AZ |
N | 213ES0131X | Foot Surgery | 0745 | AZ |
NPI | 1306088307 |
---|---|
Provider Name | Nathan Sanford Jeppesen |
First Address | Phoenix, AZ 85023-1266 |
Second Address | Mesa, AZ 85202-4712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 22/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
715319 | (05) | AZ |