Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G21271 | CA |
NPI | 1003989054 |
---|---|
Provider Name | David M Dolan |
First Address | Orange, CA 92859-0757 |
Second Address | Rancho Mirage, CA 92270-7129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 04/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90692 | (02) | CA |