Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G17819 | CA |
NPI | 1063495984 |
---|---|
Provider Name | Douglas Edward Knox |
First Address | Riverside, CA 92506-3912 |
Second Address | Riverside, CA 92506-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730180415 | GROUP NPI (01) | CA |
A40200 | (02) |