Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 55959 | AZ |
N | 207ND0101X | MOHS-Micrographic Surgeon | 55959 | AZ |
NPI | 1215374186 |
---|---|
Provider Name | Ramin Fathi |
First Address | Tucson, AZ 85718 |
Second Address | Scottsdale, AZ 85259-5499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2013 |
Last Update Date | 17/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80355 | (05) | AZ |