Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 9362 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | OMS120 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A153496 | CA |
NPI | 1013258441 |
---|---|
Provider Name | Dr. Adam Charles Marre |
First Address | Walnut Creek, CA 94596-5298 |
Second Address | La Jolla, CA 92037-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2013 |
Last Update Date | 25/02/2021 |