Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G84386 | CA |
NPI | 1013093541 |
---|---|
Provider Name | Clifford Harris |
First Address | Oakland, CA 94612-3466 |
Second Address | San Jose, CA 95119-1130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G843860 | (05) | CA |
G85571 | (02) |