Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 05-34185 | KS |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 05-34185 | KS |
N | 207Q00000X | Family Doctor | 05-34185 | KS |
NPI | 1760697890 |
---|---|
Provider Name | Troy Virgil Maypa Taduran |
First Address | Tucson, AZ 85751-1630 |
Second Address | Tucson, AZ 85745-2675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 29/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006444 | LICENSE (01) | AZ |
05-34185 | LICENSE (01) | KS |
OS 9896 | LICENSE (01) | FL |