Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G58416 | CA |
NPI | 1013187764 |
---|---|
Provider Name | David A Laub |
First Address | Mill Valley, CA 94941-6001 |
Second Address | Mill Valley, CA 94941-6001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 17/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A53403 | (02) |