Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 30413 | CT |
NPI | 1003881301 |
---|---|
Provider Name | Robert Samuelson |
First Address | Tucson, AZ 85745-2981 |
Second Address | Tucson, AZ 85745-2981 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 18/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004235900 | (05) | CT |
E85971 | (02) | CT |