Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 27633 | AZ |
NPI | 1093787749 |
---|---|
Provider Name | Raj K Bose |
First Address | Tucson, AZ 85719-1563 |
Second Address | Tucson, AZ 85718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 01/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
330005254 | RR MEDICARE (01) | AZ |
515661 | (05) | AZ |
H20527 | (02) | AZ |
ZWCGCR | GROUP MEDICARE NUMBER (01) | AZ |