Facts
- Status
- A
- Credential
- OD
- Type
- Individual
- Enumeration date
- 2006-04-26
- Last updated
- 2008-03-27
Specialties
Licenses
- License AZ
- 229
Location
- Practice location
- 421 E IOWA ST
- City
- HOLBROOK AZ
- Postal code
- 860252770
- Phone
- 928-524-6171
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.