Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 50677 | AZ |
N | 207U00000X | Nuclear Medicine Specialist | A117646 | CA |
NPI | 1366712176 |
---|---|
Provider Name | Wisam Fawzi Shaba |
First Address | Scottsdale, AZ 85258-3243 |
Second Address | Scottsdale, AZ 85258-3243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2012 |
Last Update Date | 27/01/2020 |