Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | 45334 | AZ |
NPI | 1215939566 |
---|---|
Provider Name | Nirav Y Patel |
First Address | La Crosse, WI 54601-5429 |
Second Address | Phoenix, AZ 85006-2837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 20/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76600 | (02) |