Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | C32496 | CA |
NPI | 1033178876 |
---|---|
Provider Name | Amater Zeale Traylor JR. |
First Address | Oakland, CA 94608-2804 |
Second Address | Oakland, CA 94608-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 07/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000C324960 | (05) | CA |
A34958 | (02) |