Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 17236 | AZ |
NPI | 1003844333 |
---|---|
Provider Name | Robert Serlin |
First Address | Tucson, AZ 85748 |
Second Address | Tucson, AZ 85712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 16/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
282624 | (05) | AZ |
E28406 | (02) | |
Z120968 | (02) | AZ |