Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G35713 | CA |
NPI | 1104978329 |
---|---|
Provider Name | Charles F. Rieder |
First Address | Oakland, CA 94612-3429 |
Second Address | Walnut Creek, CA 94596-5318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G357130 | (05) | CA |
F05657 | (02) |