Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | C33404 | CA |
NPI | 1215960430 |
---|---|
Provider Name | Dr. Anthony Somkin |
First Address | Petaluma, CA 94954-1469 |
Second Address | Berkeley, CA 94704-2636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 08/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A35261 | (02) | CA |