Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 53491 | AZ |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 53491 | AZ |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 53491 | AZ |
NPI | 1295272334 |
---|---|
Provider Name | Niloofar Dehghan |
First Address | Phoenix, AZ 85023-1261 |
Second Address | Phoenix, AZ 85023-1261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2017 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | AZ |