Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 27674 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 59421 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A112886 | CA |
NPI | 1265493373 |
---|---|
Provider Name | Derrick Flint |
First Address | San Francisco, CA 94143-2206 |
Second Address | San Francisco, CA 94143-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 15/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I43636 | (02) | NY |