Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 14985 | AZ |
NPI | 1023060456 |
---|---|
Provider Name | Roy Jedeikin |
First Address | Phoenix, AZ 85006-1459 |
Second Address | Phoenix, AZ 85006-1459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 10/02/2012 |