Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 27659 | AZ |
NPI | 1083633796 |
---|---|
Provider Name | Randy Oppenheimer |
First Address | Phoenix, AZ 85016-8034 |
Second Address | Phoenix, AZ 85008-4973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
766529 | (05) | AZ |
E07425 | (02) | AZ |