Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 12584 | AZ |
NPI | 1003818238 |
---|---|
Provider Name | Stanley J Suffecool |
First Address | Tucson, AZ 85715-3808 |
Second Address | Tucson, AZ 85715-3808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 10/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205618 | (05) | AZ |
D00390 | (02) |