Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 24667 | AZ |
Y | 207RI0011X | Interventional Cardiology | 24667 | AZ |
NPI | 1063413177 |
---|---|
Provider Name | Warren Mark Breisblatt |
First Address | Phoenix, AZ 85027-4171 |
Second Address | Phoenix, AZ 85020-2425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370247 | (05) | AZ |
B41649 | (02) |