Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 007575 | AZ |
N | 208D00000X | General Practice Physician | 0102203037 | VA |
NPI | 1013235886 |
---|---|
Provider Name | Thomas J Bayuk |
First Address | Nellis Afb, NV 89191-6600 |
Second Address | Phoenix, AZ 85013-4422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 19/09/2018 |