Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 17502 | AZ |
Y | 208600000X | Surgeon | 17502 | AZ |
NPI | 1023041183 |
---|---|
Provider Name | Thomas J Drouhard |
First Address | Tuba City, AZ 86045-0600 |
Second Address | Tuba City, AZ 86045-0600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 10/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
419798 | (05) | AZ |
H43162 | (02) |