Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 25835 | IA |
NPI | 1083705339 |
---|---|
Provider Name | Prof. John Duncan Corson |
First Address | Albuquerque, NM 87111-7411 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |