Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A49855 | CA |
Y | 207PP0204X | Pediatric Emergency Physician | A49855 | CA |
N | 208000000X | Pediatrician | A49855 | CA |
NPI | 1639105489 |
---|---|
Provider Name | Dr. Bernard Wilhelm Dannenberg |
First Address | Arcadia, CA 91066-0579 |
Second Address | Palo Alto, CA 94304-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 14/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A498550 | (05) | CA |
F11344 | (02) | CA |