Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G39211 | CA |
NPI | 1225182181 |
---|---|
Provider Name | David White |
First Address | Mountain View, CA 94040-6201 |
Second Address | Palo Alto, CA 94301-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 06/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A47741 | (02) | CA |