Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 00C37479 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 00C37479 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 00C37479 | CA |
NPI | 1417920760 |
---|---|
Provider Name | Dr. Airell Leighton Nygaard |
First Address | Sonora, CA 95370-5288 |
Second Address | Sonora, CA 95370-5288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 30/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C37479 | (05) | CA |
00C37479 | CA MEDICAL LICENSE # (01) | CA |
20859 | (02) | CA |
431973118 | CORPORATE TAX ID # (01) | CA |