Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 0116027734 | VA |
Y | 204F00000X | Transplant Surgeon | 293587 | NY |
NPI | 1730569633 |
---|---|
Provider Name | Rauf Shahbazov |
First Address | Syracuse, NY 13212 |
Second Address | Syracuse, NY 13210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 02/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730569633 | (05) | VA |