Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | C500740 | CA |
Y | 207NS0135X | Procedural Dermatology | C500740 | CA |
NPI | 1013943836 |
---|---|
Provider Name | Christopher Bransby Zachary |
First Address | Orange, CA 92868-3201 |
Second Address | Irvine, CA 92697-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 30/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C500740 | (05) | CA |
A96575 | (02) | CA |