Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A065692 | CA |
NPI | 1013063437 |
---|---|
Provider Name | David Scott Michelson |
First Address | La Jolla, CA 92037-1223 |
Second Address | La Jolla, CA 92037-1223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A065692 | STATE LICENSE NUMBER (01) | CA |
G71015 | (02) | CA |