Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 9005 | AZ |
NPI | 1083605893 |
---|---|
Provider Name | Ole Borch-Christensen |
First Address | Glendale, AZ 85304-1255 |
Second Address | Glendale, AZ 85304-1255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
222620 | (05) | AZ |
E31348 | (02) |