Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 6517 | AZ |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036.124716 | IL |
NPI | 1699896027 |
---|---|
Provider Name | Tracey Knott |
First Address | Chandler, AZ 85224-6239 |
Second Address | Gilbert, AZ 85297-2100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
937755 | (05) | AZ |