Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 20848 | AZ |
NPI | 1164410627 |
---|---|
Provider Name | Zoran Maric |
First Address | Phoenix, AZ 85013-4417 |
Second Address | Phoenix, AZ 85013-4417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 09/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115289 | (05) | AZ |
3Z3920 | HEALTHNET (01) | AZ |
F35578 | (02) | AZ |