Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 37682 | AZ |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 37682 | AZ |
NPI | 1336121102 |
---|---|
Provider Name | Scott William Siverhus |
First Address | Phoenix, AZ 85023-1266 |
Second Address | Phoenix, AZ 85023-1264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
321699 | (05) | AZ |
5550830001 | MEDICARE NSC SCW (01) | AZ |
5550830003 | MEDICARE NSC PEORIA (01) | AZ |
5550830007 | MEDICARE NSC DV (01) | AZ |
5550830010 | MEDICARE NSC GILBERT (01) | AZ |
5550830011 | MEDICARE NSC CENTRAL (01) | AZ |
5550830012 | MEDICARE NSC SPINE CENTER (01) | AZ |
F57242 | (02) |