Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 8455 | AZ |
NPI | 1003880741 |
---|---|
Provider Name | Stuart Hameroff |
First Address | Tucson, AZ 85706-7124 |
Second Address | Tucson, AZ 85724-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 30/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050025543 | RAILROAD MEDICARE (01) | AZ |
237752 | (05) | AZ |
D36974 | (02) | AZ |