Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E-5052 | CA |
N | 213ES0103X | Foot & Ankle Surgery | EL1790 | CA |
NPI | 1013235357 |
---|---|
Provider Name | Alan Wesley Sue |
First Address | Berkeley, CA 94710-1955 |
Second Address | Berkeley, CA 94710-1955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2010 |
Last Update Date | 20/04/2013 |