Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 18781 | AZ |
NPI | 1205897618 |
---|---|
Provider Name | Peggy J Radford |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 11/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063503 | (05) | AZ |
F14086 | (02) |