Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A25669 | CA |
NPI | 1275528572 |
---|---|
Provider Name | Adam H Marvin |
First Address | Oakland, CA 94609-3426 |
Second Address | Oakland, CA 94609-3426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 27/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24527 | (02) |