Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 203365 | LA |
Y | 207RI0200X | Infectious Disease | 45091 | AZ |
NPI | 1083828750 |
---|---|
Provider Name | Samuel H Bairu |
First Address | Glendale, AZ 85308-1660 |
Second Address | Sun City West, AZ 85375-5282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
664569 | (05) | AZ |