Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3384 | CA |
Y | 222Z00000X | Podiatrist | E3384 | CA |
N | 213ES0131X | Foot Surgery | 9403 | NV |
NPI | 1225127673 |
---|---|
Provider Name | David E Condon |
First Address | Truckee, CA 96162-0069 |
Second Address | Truckee, CA 96161-0432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 10/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11666 | (02) | CA |