Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A41200 | CA |
NPI | 1053404970 |
---|---|
Provider Name | Charles Eric Gage |
First Address | Sacramento, CA 95827-2539 |
Second Address | Roseville, CA 95661-3087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 03/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A412000 | (05) | CA |
A88553 | (02) |