Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 33179 | AZ |
N | 207RP1001X | Pulmonary Disease | 33179 | AZ |
Y | 207RP1001X | Pulmonary Disease | 958 | WI |
NPI | 1053320168 |
---|---|
Provider Name | Richard D Sue |
First Address | Phoenix, AZ 85012-2368 |
Second Address | Phoenix, AZ 85012-2368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 28/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
877491 | (05) | AZ |
G48583 | (02) |