Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0214X | Pediatric Pulmonologist | 21437 | AL |
Y | 2080P0214X | Pediatric Pulmonologist | 38210 | AZ |
NPI | 1154430205 |
---|---|
Provider Name | Roni Grad |
First Address | Tucson, AZ 85706-7124 |
Second Address | Tucson, AZ 85711-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000076400 | (05) | AL |
000076613 | (05) | AL |
277071 | (05) | AZ |
D43987 | (02) |