Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G29417 | CA |
NPI | 1043384340 |
---|---|
Provider Name | Bon B. Hartline |
First Address | Oakland, CA 94612-3429 |
Second Address | Oakland, CA 94611-5642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A44033 | (02) |