Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 20A18243 | CA |
NPI | 1083062475 |
---|---|
Provider Name | Beau Kalmes |
First Address | Lumberton, NC 28358-3075 |
Second Address | Fresno, CA 93720-3391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 30/06/2020 |